Prosthesis related sepsis following laparoscopic adjustable gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is well-recognized as a superior method to achieving durable weight loss in the medium term when compared with non-surgical methods of weight loss. In this paper, we described the clinical presentation and outcomes of patients presenting with band or band-adjustment reservoir sepsis from our series from a single institution. METHODS: We conducted a retrospective review of prospectively collected clinical, anthropometric and biochemical data from patients who underwent LAGB placement over a five-year period at a metropolitan teaching hospital. Those patients requiring surgical intervention for prosthesis-related sepsis were included in the review. RESULTS: Of the 445 patients in this series, 10 (2.2%) developed prosthesis sepsis and required operative intervention. Three (0.7%) presented with reservoir sepsis requiring removal of the reservoir. One had band erosion identified and the entire prosthesis removed. In seven (1.5%) of the patients, infections occurred at the gastric band. Two patients presented with purulent peritonitis and underwent immediate band removal. The remainder presented with band abscesses and either had their band removed (three patients) or left in position and the sepsis treated with drainage and antibiotics (two patients). CONCLUSIONS: In our current series, a small proportion of LAGB patients developed prosthesis-related infection that typically required port or band removal and usually occurred early in the post-operative course. We have modified our prophylactic antibiotic regime and surgical technique as a result of this review. In selected cases of band infection, bands were salvaged with subsequent acceptable weight loss, suggesting that LAGB salvage in the presence of sepsis may be achievable in some patients.

Phenotypical and genotypical characteristics of invasive group B Streptococcus isolates in Western Sydney 2000-2005.

AIMS: To analyse antimicrobial susceptibility and serotypes of group B streptococcus (GBS) bloodstream isolates from different patient groups. METHODS: Susceptibility to penicillin, erythromycin and clindamycin was measured for 99 bloodstream GBS isolates collected between October 2000 and July 2005. Multiplex PCR-based reverse line blot (mPCR/RLB) assays were used to identify macrolide resistance genes and capsular serotype for each isolate. Clinical correlation was obtained from chart review. RESULTS: Adult bacteraemia accounted for 84 of 99 (85%) isolates, and were usually associated with underlying diseases such as diabetes, malignancy and renal failure. Overall mortality was 10%. Known macrolide resistance genes [ermB (2), ermA/TR (3) and mefA/E (2)] were detected in seven of eight erythromycin resistance isolates. Four of these isolates expressed MLSB phenotype, two with constitutive (ermB) and two with inducible (ermA/TR) clindamycin resistance. Of four M phenotype isolates, two had mefA/E, one had ermA/TR and one had no detectable macrolide resistance genes. Serotype III was significantly more common in neonatal isolates; serotype V was more common among adult isolates and was associated with increased mortality. CONCLUSIONS: mPCR/RLB is a rapid molecular method to identify GBS serotype and macrolide resistance genes. This is the first major study correlating these characteristics with demographic data for invasive isolates.

Necrotizing infection due to Bacillus cereus mimicking gas gangrene following penetrating trauma.

An 8-year-old boy presented with fulminant necrotizing infection resembling gas gangrene following penetrating trauma from a tree branch. Bacillus cereus was isolated from tissue specimens, showing that unexpected pathogens can be isolated. It is essential to submit specimens for culture, as this organism is typically resistant to beta-lactam antibiotics and metronidazole, the empiric choice for gas gangrene.