RESUMO
Infectious native aortic aneurysm (INAA) are rare but life-threatening infections. Early microbiological identification is crucial to initiate adequate therapy and decrease the peri-operative risk, but can be challenging when blood cultures remain negative. We describe two cases of pneumococcal INAA with negative blood cultures, diagnosed in the with the pneumococcal urinary antigen test.
Assuntos
Aneurisma Aórtico , Doenças Transmissíveis , Infecções Pneumocócicas , Humanos , Antibacterianos/uso terapêutico , Hemocultura , Streptococcus pneumoniae , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/cirurgia , Aneurisma Aórtico/tratamento farmacológico , Doenças Transmissíveis/tratamento farmacológico , Antígenos de Bactérias/urinaRESUMO
This is a case report on the use of Eckardt keratoprosthesis for pars plana vitrectomy in a patient with endophthalmitis and suppurative keratitis that developed after cataract surgery. A 79-year-old woman developed acute-onset infectious endophthalmitis and suppurative keratitis after cataract surgery that failed to respond to treatment with antibiotic eyedrops and intravitreal antibiotic injection. Using a temporary keratoprosthesis that enabled sufficient visualization, vitrectomy was performed, followed by therapeutic keratoplasty using a cryopreserved donor cornea. The patient's vision was improved from light perception to counting fingers at 30 cm, 3 months postoperatively. There was no recurrence of infection or other significant complications.
Assuntos
Úlcera da Córnea/cirurgia , Endoftalmite/cirurgia , Infecções Oculares Bacterianas/cirurgia , Infecções Pneumocócicas/cirurgia , Complicações Pós-Operatórias , Próteses e Implantes , Streptococcus pneumoniae/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Úlcera da Córnea/microbiologia , Quimioterapia Combinada , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Glaucoma de Ângulo Fechado/cirurgia , Glucocorticoides/uso terapêutico , Humanos , Iridectomia , Ceratoplastia Penetrante , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/microbiologia , Acuidade Visual/fisiologia , VitrectomiaAssuntos
Bevacizumab/uso terapêutico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Linfoma Intraocular/diagnóstico , Linfoma Extranodal de Células T-NK/diagnóstico , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Endoftalmite/tratamento farmacológico , Endoftalmite/cirurgia , Evisceração do Olho , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/cirurgia , Humanos , Injeções Intravítreas , Masculino , Órbita/diagnóstico por imagem , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
Gynaecological infections are frequent in women, particularly in young women during their reproductive time. Anatomophysiologically, Bartholin's gland is greatly susceptible to infections and is characterised by an inherent polymicrobial population. In fact, gynaecological microbiota has a set of agents coming from the perianal region that colonise the vagina and, in particular, Bartholin's gland. Taking this into account, infections caused by agents that do not belong to the genital microbiota are less frequent. Here, we describe a case of a 23-year-old young woman with an abscess in Bartholin's gland caused by Streptococcus pneumoniae.
Assuntos
Abscesso/cirurgia , Glândulas Vestibulares Maiores/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Doenças da Vulva/microbiologia , Abscesso/tratamento farmacológico , Abscesso/patologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Glândulas Vestibulares Maiores/patologia , Diagnóstico Diferencial , Drenagem/métodos , Feminino , Humanos , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/patologia , Infecções Pneumocócicas/cirurgia , Resultado do Tratamento , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/patologia , Doenças da Vulva/cirurgia , Adulto JovemRESUMO
Purpura fulminans is a rapidly progressive syndrome of intravascular thrombosis and hemorrhagic infarction of the skin. The most common infectious etiology is Neisseria meningitidis sepsis, and less commonly it has been documented as a complication of invasive Streptococcus pneumoniae In children who are otherwise healthy, splenic dysfunction is a significant predisposing factor for invasive pneumococcal infection. We present the case of a 10-month-old girl with a history of developmental delay, who developed an overwhelming infection complicated by purpura fulminans and was found to have previously undiagnosed Mowat-Wilson syndrome with anatomic asplenia. We propose screening patients with clinical features suggestive of Mowat-Wilson syndrome for asplenia to evaluate the need for additional preventive care.
Assuntos
Doença de Hirschsprung/diagnóstico , Deficiência Intelectual/diagnóstico , Microcefalia/diagnóstico , Infecções Pneumocócicas/diagnóstico , Púrpura Fulminante/diagnóstico , Streptococcus pneumoniae/isolamento & purificação , Amputação Cirúrgica/métodos , Diagnóstico Diferencial , Fácies , Feminino , Doença de Hirschsprung/complicações , Doença de Hirschsprung/cirurgia , Humanos , Lactente , Deficiência Intelectual/complicações , Deficiência Intelectual/cirurgia , Microcefalia/complicações , Microcefalia/cirurgia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/cirurgia , Púrpura Fulminante/complicações , Púrpura Fulminante/cirurgiaAssuntos
Endoftalmite/diagnóstico , Dor Ocular/microbiologia , Infecções Pneumocócicas/diagnóstico , Streptococcus pneumoniae , Adolescente , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Endoftalmite/tratamento farmacológico , Endoftalmite/cirurgia , Feminino , Humanos , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/cirurgia , VitrectomiaRESUMO
Streptococcus pneumoniae es un patógeno habitual en infecciones del tracto respiratorio y representa la causa más frecuente de neumonía, otitis media y sinusitis. Excepcionalmente, y de forma transitoria, puede colonizar el tracto genital inferior y ser causa de enfermedad pélvica inflamatoria y peritonitis secundaria. El objetivo es presentar un caso con el diagnóstico de absceso tubo-ovárico izquierdo con un germen poco común en esta localización. Se presenta el caso de una paciente de 52 años, histerectomizada desde hace 12 años con una inmunodepresión secundaria como factor predisponente para el desarrollo de esta complicación. Se realizó laparotomía y se realizó exéresis de la tumoración y el cultivo microbiológico del contenido de ella. Se diagnosticó una infección por Streptococcus pneumoniae. La evolución posoperatoria fue satisfactoria(AU)
Streptococcus pneumoniae is a common pathogen in respiratory tract infections and the most common cause of pneumonia, otitis media, and sinusitis. Exceptionally, and transiently, it can colonize the lower genital tract causing pelvic inflammatory disease and secondary peritonitis. The objective is to present a case with left tube-ovarian abscess diagnosis, with a rare germ at this location. The case of a 52-year-old patient is reported here. She was hysterectomized 12 years before with secondary immunosuppression as a predisposing factor for developing this complication. A laparotomy was performed and excision of the tumor and microbiological culture of the contents of the tumor were completed. Streptococcus pneumoniae was diagnosed. Postoperative evolution was satisfactory(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/cirurgiaRESUMO
We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy.
Assuntos
Antibacterianos/uso terapêutico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/cirurgia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/cirurgia , Parede Torácica/fisiopatologia , Parede Torácica/cirurgia , Idoso , Povo Asiático , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/cirurgia , Feminino , Humanos , Japão , Abscesso Pulmonar/fisiopatologia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/patogenicidade , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Endoftalmite/etiologia , Injeções Intravítreas/efeitos adversos , Infecções Pneumocócicas/etiologia , Ranibizumab/efeitos adversos , Idoso , Antibacterianos/uso terapêutico , Terapia Combinada , Desinfecção , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Endoftalmite/cirurgia , Enucleação Ocular , Humanos , Degeneração Macular/tratamento farmacológico , Masculino , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/cirurgia , Prednisona/uso terapêutico , Ranibizumab/administração & dosagem , Ranibizumab/uso terapêutico , Sorogrupo , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Vitrectomia , Corpo Vítreo/microbiologiaRESUMO
Infectious arteritis is an insidious condition commonly associated with a long diagnostic delay. We report the management of extensive pneumococcal thoracic aortitis in a 64-year-old woman. The frozen elephant trunk procedure was performed to repair the aortic arch. Prolonged aortic wall cultures were positive for Streptococcus pneumoniae. Late follow-up imaging at 36 months demonstrated no sign of recurrence around the hybrid vascular graft in the thoracic aorta.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Aortite/cirurgia , Implante de Prótese Vascular/métodos , Infecções Pneumocócicas/cirurgia , Streptococcus pneumoniae/isolamento & purificação , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Aortite/diagnóstico por imagem , Aortite/microbiologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico por imagem , Infecções Pneumocócicas/microbiologia , Resultado do TratamentoAssuntos
Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Infecções Pneumocócicas/cirurgia , Valva Tricúspide/cirurgia , Endocardite Bacteriana/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/microbiologia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico por imagem , Síndrome , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/microbiologiaRESUMO
Case series have suggested that pneumococcal endocarditis is a rare disease, mostly reported in patients with co-morbidities but no underlying valve disease, with a rapid progression to heart failure, and high mortality. We performed a case-control study of 28 patients with pneumococcal endocarditis (cases), and 56 patients with non-pneumococcal endocarditis (controls), not matched for sex and age, during the years 1991-2013, in one referral centre. Alcoholism (39.3% versus 10.7%; p <0.01), smoking (60.7% versus 21.4%; p <0.01), the absence of previously known valve disease (82.1% versus 60.7%; p 0.047), heart failure (64.3% versus 23.2%; p <0.01) and shock (53.6% versus 23.2%; p <0.01) were more common in pneumococcal than in non-pneumococcal endocarditis. Cardiac surgery was required in 64.3% of patients with pneumococcal endocarditis, much earlier than in patients with non-pneumococcal endocarditis (mean time from symptom onset, 14.1 ± 18.2 versus 69.0 ± 61.1 days). In-hospital mortality rates were similar (7.1% versus 12.5%). Streptococcus pneumoniae causes rapidly progressive endocarditis requiring life-saving early cardiac surgery in most cases.
Assuntos
Endocardite/patologia , Infecções Pneumocócicas/patologia , Streptococcus pneumoniae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Endocardite/mortalidade , Endocardite/cirurgia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/mortalidade , Infecções Pneumocócicas/cirurgia , Prognóstico , Análise de Sobrevida , Resultado do TratamentoRESUMO
Infectious aortitis is a rare clinical entity that most often manifests itself by an aortic aneurysm. The syphilitic or tubercular forms can be subacute. When it is caused by Salmonella sp., Staphylococcus sp. or Streptococcus pneumoniae, the aortitis is acute with alarming symptoms. Germs found in most cases are Salmonella and Staphylococcus aureus. S. pneumoniae rarely causes infectious aortitis. We report the case of a 75-year-old patient seen in an emergency setting for sudden-onset abdominal pain with fever. An abdominal angio-computed tomography (CT) scan showed a sacciform infrarenal abdominal aortic aneurysm, with an inflammatory aspect and periaortic hematoma. Surgical cure was undertaken because of the impending rupture. An interposition aortic replacement graft was implanted. Blood cultures and bacteriological study of the aortic wall isolated a S. pneumoniae. The anatomical pathology study reported fibrin clot leukocyte remodeling of the aortic wall. An intravenous antibiotic regimen was started. Several organisms, including Streptococcus, can cause infectious aortitis. We found 36 cases described in the literature in addition to our patient.
Assuntos
Aneurisma Infectado/microbiologia , Aortite/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Dor Abdominal/etiologia , Idoso , Amoxicilina/uso terapêutico , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/tratamento farmacológico , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/microbiologia , Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/tratamento farmacológico , Aneurisma da Aorta Abdominal/cirurgia , Aortite/diagnóstico por imagem , Aortite/tratamento farmacológico , Aortite/cirurgia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Implante de Prótese Vascular , Ceftriaxona/uso terapêutico , Terapia Combinada , Febre/etiologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A mycotic aneurysm that also involves the visceral arteries is a life-threatening condition. Surgical management typically consists of débridement and in situ repair with a Dacron graft and reimplantation of the involved visceral branches. We report a rare case of a mycotic saccular thoracoabdominal aortic aneurysm involving the celiac artery, with Streptococcus pneumoniae as the responsible organism. Successful repair of the aneurysm and concomitant revascularization of the celiac artery were achieved.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Artéria Celíaca/cirurgia , Infecções Pneumocócicas/cirurgia , Streptococcus pneumoniae/isolamento & purificação , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/administração & dosagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/microbiologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico por imagem , Infecções Pneumocócicas/microbiologia , Desenho de Prótese , Reimplante , Técnicas de Sutura , Resultado do TratamentoAssuntos
Artrite Infecciosa/complicações , Vértebras Lombares/microbiologia , Meningoencefalite/etiologia , Infecções Pneumocócicas/etiologia , Articulação Zigapofisária/microbiologia , Artrite Infecciosa/microbiologia , Feminino , Humanos , Dor Lombar/etiologia , Imageamento por Ressonância Magnética , Meningoencefalite/tratamento farmacológico , Meningoencefalite/cirurgia , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/cirurgia , Fatores de RiscoRESUMO
BACKGROUND: An empyema is an infection of the pleural space that occurs most frequently secondary to the progression of pneumonia. The stages of empyema are based on pleural characteristics and reflect the risks of the condition for morbidity and mortality. Pregnancy is a risk factor for major complications of pneumonia, including empyema. CASE: A pregnant woman at 25 weeks' gestation with a community-acquired Streptococcus pneumoniae pneumonia underwent video-assisted thoracotomy decortication and debridement of a large loculated, gelatinous empyema after conservative medical therapy failed. CONCLUSION: Conservative medical therapy with antibiotics alone may not be adequate for advanced bacterial empyema in pregnancy.
Assuntos
Empiema Pleural/cirurgia , Infecções Pneumocócicas/cirurgia , Complicações Infecciosas na Gravidez/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Empiema Pleural/microbiologia , Feminino , Humanos , Gravidez , Segundo Trimestre da GravidezRESUMO
BACKGROUND: The widespread use of the 7-valent pneumococcal conjugate vaccine has been associated with epidemiologic changes of mucosal and invasive pneumococcal disease. No study describes the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on chronic sinusitis in children. We describe changes in epidemiology of Streptococcus pneumoniae chronic sinusitis after the introduction of PCV13 at Texas Children's Hospital. METHODS: We identified patients <18 years with positive sinus culture for S. pneumoniae who underwent endoscopic sinus surgery because of chronic sinusitis from August 2008 to December 2013 at Texas Children's Hospital. Isolates were serotyped by the capsular swelling method. Demographic and clinical information was collected retrospectively. The χ test and Fisher's exact test were used to analyze dichotomous variables. RESULTS: We identified 91 cases of chronic sinusitis with positive sinus culture for S. pneumoniae. Sixty-one (67%) isolates were non-PCV13 serotypes. PCV13 cases decreased 31% in the post-PCV13 period (P = 0.003). Serotype 19A decreased 27% in the post-PCV13 period (P = 0.007), but accounted for all the isolates with penicillin minimal inhibitory concentration ≥ 4 µg/mL and ceftriaxone minimal inhibitory concentration ≥ 2 µg/mL. Serotypes 19A (38%) and 15C (17%) were the most common in the pre- and post-PCV13 periods, respectively. The most common organism co-isolated was Haemophilus influenzae (52%). Isolation of Prevotella spp. increased in the post-PCV13 period (P = 0.02). CONCLUSIONS: S. pneumoniae continues to represent an important pathogen in chronic sinusitis in children <5 years of age. After the introduction of PCV13, S. pneumoniae isolation declined in children with chronic sinusitis at Texas Children's Hospital. We also observed a substantial reduction of PCV13 serotypes, predominantly serotype 19A.
Assuntos
Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Sinusite/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Antibacterianos/farmacologia , Criança , Pré-Escolar , Doença Crônica , Endoscopia , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/cirurgia , Sorogrupo , Sorotipagem , Sinusite/microbiologia , Sinusite/cirurgia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Texas/epidemiologiaRESUMO
Primary mycotic aneurysms of the aorta are a rare but life-threatening condition. A 59-year-old woman developed a back abscess secondary to an insect bite. A computed tomography scan revealed 3 concomitant mycotic aneurysms, including a rupture. Staged repair was undertaken: immediate open repair for contained rupture of a type IV thoracoabdominal aortic aneurysm, followed by endovascular repair of a descending thoracic aneurysm 3 weeks later and finally an aortic arch hybrid repair of a left subclavian artery aneurysm 16 months later. She remains well postoperatively. There is currently no consensus on the timing of repair or modality of treatment of mycotic aneurysms. Each patient should be treated individually based on aneurysm location, rupture, and comorbidities, as shown by this case.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Infecções por Bacteroidaceae/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Mordeduras e Picadas de Insetos/complicações , Infecções Pneumocócicas/cirurgia , Prevotella/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/microbiologia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/microbiologia , Aortografia/métodos , Infecções por Bacteroidaceae/diagnóstico , Infecções por Bacteroidaceae/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: The V. A. C. INSTILL® therapy is an innovative process for treating chronic wounds that are not optimally accessible to a systemic antibiotic therapy or infected with multi-resistant pathogens. We report on our first experience and applications of V. A. C. INSTILL® therapy in the field of septic thoracic surgery. MATERIALS AND METHODS: V. A. C. INSTILL therapy was used in 11 cases between 11/2009 and 01/2012. Three patients had sternum osteomyelitis (2 MRSA, 1 Finegoldia magna). In 3 patients chronic pleural empyema after lobectomy (1 Streptococcus viridans, 1 mixed infection with MRSA among others) and after pneumectomy (1 MRSA) were detected. In 2 cases there was an acute pleural empyema with extensive phlegmona in the region of the thoracic soft tissues (2 streptococci). In 1 patient a chronic pleural empyema with MRSA infection was treated. Septic arthritis of the sternoclavicular joint with joint destruction and extensive phlegmona in the region of the cervical soft tissues (1 Streptococcus pneumoniae, 1 Staphylococcus aureus) was treated in 2 patients. In all cases instillation of the wound was performed with Lavasept 0.2 %. Swabs of the wound were taken before starting and after ending V. A. C. INSTILL® therapy as well as before wound closure. RESULTS: Mean patient age was 48.8 ± 18.9 years. V. A. C. INSTILL® therapy was performed for 6.5 ± 1.7 days. Instillation time amounted to 21.7 ± 5.7 s. The duration of action was standardised at 18 min in all cases. In 2 cases (1 MESA, 1 finegoldia) the V. A. C. INSTILL® therapy was repeated. In 10 patients a sterile wound status was achieved before secondary wound closure. All wounds underwent secondary closure without recurrence. CONCLUSIONS: Chronic osteomyelitis with MRSA infections as well as chronically infected residual cavities after empyema surgery and extensive phlegmona are possible indications for V. A. C. INSTILL® therapy in order to help eradicating the infection as quickly and as completely as possible.