Tricuspid valve infective endocarditis complicated with multiple lung abscesses and thoracic empyema as different pathogens: a case report.

BACKGROUND: Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare. CASE PRESENTATION: We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle. CONCLUSION: The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.

Repair of ascending aortic pseudoaneurysm eroding through the sternum.

In reoperation for an ascending aortic pseudoaneurysm eroding through the sternum, a left ventricular vent allows careful unhurried sternal division under deep hypothermic circulatory arrest. We repaired ascending aortic pseudoaneurysms in 2 patients who had undergone aortic valve implantation 6 and 21 months earlier. A minithoracotomy was made in the left 5th intercostal space, and a vent was placed in the left ventricular apex. Repair was accomplished with a bovine pericardial patch reinforced with a Teflon felt strip. Both patients made an uneventful recovery with good functional status at discharge at the 8- and 18-month follow-up.

Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery.

We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed.

Infected Nonhealing Wound in a Kidney Transplant Recipient: Successful Treatment With Topical Homologous Platelet-Rich Gel.

Impaired would healing is a known adverse effect of chronic immunosuppression. Solid-organ transplant recipients undergoing major abdominal surgery have an increased risk of wound-related complications compared with the general population. In this subset of patients, surgical site infections and wound dehiscence must be aggressively treated to avoid sepsis, graft loss, and death. Recently, topical application of platelet-rich plasma has been proposed as an alternative therapeutic option to enhance wound healing in difficult cases. Unfortunately, randomized controlled trials evaluating the efficacy of platelet-rich plasma compared with standard or advanced wound management are lacking, and the literature mostly refers to anecdotal reports in patients with no evidence of wound infection. This report documents a kidney transplant recipient who experienced spontaneous bladder rupture because of gangrenous cystitis. After an exploratory laparotomy and bladder repair, the patient developed a deep surgical site infection by multidrug resistant Acinetobacter baumannii and extensive wound dehiscence. Advanced wound management and vacuum-assisted closure therapy were ineffective. Topical homologous platelet-rich gel was used resulting in significant wound healing, without infections or immunologic complications.

Bronchoscopic Drainage of Lung Abscesses Using a Pigtail Catheter.

BACKGROUND: Lung abscesses are commonly treated with antibiotics. However, some patients fail to respond and may require percutaneous catheter drainage or surgical intervention. Bronchoscopic drainage (BD) of lung abscesses emerged as a therapeutic alternative in selected patients. OBJECTIVE: To describe our experience with 15 patients who underwent BD at our center during 2006-2016. METHODS: Patients underwent flexible bronchoscopy. Under fluoroscopic guidance, a pigtail catheter was introduced into the abscess cavity, its correct position being confirmed by the injection of contrast medium. The catheter remained in place for a few days and was flushed repeatedly with antibiotics. RESULTS: Fifteen patients (9 males; median age 59 years) underwent 16 BD procedures. A pigtail catheter was successfully inserted and pus was drained from the abscess cavity in 13 procedures (81%) conducted in 12 patients, leading to rapid clinical improvement in 10 of them; resolution of fever occurred a median of 2 days (range <1-4) following pigtail insertion, and patients were discharged after 8 days (range 4-21). The pigtail catheter was extracted after a median of 4 days (range 2-6). CONCLUSION: BD of lung abscesses was achieved in 13 out of 16 procedures, leading to rapid improvement in the majority of patients. This work adds to the existing literature in establishing this procedure as an acceptable therapeutic alternative in selected patients who fail to respond to antibiotics, especially those with an airway obstruction or a fairly central lung abscess.

[Infection of chronic otitis media with Acinetobacter：6 cases report].

Objective:To investigate the clinical characteristics, diagnostic methods and prognosis of patients with chronic otitis media with Acinetobacter infection. Method:Retrospective analysis of clinical data of 6 cases of chronic otitis media complicated with Acinetobacter infection. Including history, clinical manifestations, laboratory examination, audiology, inner ear, CT, MRI imaging characteristics, treatment and prognosis of etc. to summarize the clinical characteristics, diagnosis and treatment of chronic otitis media with Acinetobacter infection. Result:The age was between 17 years old and 61 years old (Median age 30 years) .Two of them was male and 4 were female. Four cases were had underlying diseases. Five cases with main symptom of cholesteatoma, 1 case with earache symptoms, and 1 case with facial paralysis symptoms. Four cases had vary degrees of physical decline and destruction of bone. After surgery treatment, five patients improved ear pus, among 3 cases was cured, 2 cases of recurrence. Conclusion:Chronic otitis media with Acinetobacter infection occurs in the patient with elderly, poor physical constitution. However, the recurrence rate of conventional treatment is higher. The disease has high misdiagnosis rate. Operation combined with sensitive antibiotic therapy is a radical cure method.

[Cervico-facial cellulitis during pregnancy: about a series of 10 cases in Mali]. / Cellulite cervico-faciale au cours de la grossesse. À propos d'une série de 10 cas au Mali.

The objective of this work was to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis on pregnancies and to determine maternal-fetal prognosis. We conducted a longitudinal observational descriptive study from January 2011 to March 2013 including records from pregnant women with cervicofacial cellulitis treated at the Oto-Rhino-Laryngology (ORL) and cervico-facial surgery department at Gabriel Touré Hospital in Bamako. Ten women met our inclusion criteria. The median age was 23 years. The entry way was dental in all cases. Three women had taken antibiotics and 3 others antibiotics associated with non steroidal anti-inflammatory. The medico-surgical treatment had permitted to cure 8 cases. Two cases of death were recorded and 4 cases of stillbirths. The cervico-facial cellulitis during pregnancy is a serious pathology that can be life-threatening to the mother and or child. Prevention is based on the control of dental status and informing women about the importance of dental hygiene.

Management of mycotic femoral artery aneurysm with two resistant organisms.

We report the management of a case of thigh abscess with ruptured left superficial femoral artery mycotic aneurysm in a 91-year-old woman with significant comorbidity. The abscess culture grew Escherichia coli and Acinetobacter baumannii. Vascular reconstruction was not performed because the foot was viable with a heavily contaminated wound. The thigh wound healed with the help of vacuum-assisted closure. This is the first report of a ruptured mycotic aneurysm of the superficial femoral artery associated with Escherichia coli and Acinetobacter baumannii infection. This case demonstrates that resection of a mycotic aneurysm without vascular continuity is feasible, especially in frail patients.

Revision liver transplant for persistent infection and localized aspergillosis after hepatic artery thrombosis.

Early hepatic artery thrombosis after liver transplant may be complicated by aggressive aspergillosis and bacterial infections that may cause morbidity and mortality. The definitive treatment of hepatic artery thrombosis is revision transplant. However, sepsis may be a contraindication to revision transplant. A 37-year-old man developed hepatic artery thrombosis at 3 days after liver transplant. During the treatment of hepatic artery thrombosis, he developed multiple biliary, bacterial, and fungal infections. Evaluation showed aspergillosis with multiple intrahepatic abscesses. He was treated with antibiotic and antifungal drugs. Despite active sepsis, revision transplant was performed and the infection resolved. Although sepsis may be a contraindication for transplant surgery, revision transplant was successful, probably because the primary transplanted liver was the source of infection.

Predictors of mortality in surgical patients with Acinetobacter baumannii bacteremia.

BACKGROUND: Acinetobacter baumannii has emerged as an important pathogen of nosocomial infection. The aim of this study was to evaluate the predictors of poor outcome in surgical patients with A baumannii bacteremia. METHODS: We retrospectively recruited a total of 50 patients who developed A baumannii bacteremia within 2 weeks after surgery during a 113-month period. The primary outcome for this study was all-cause 14-day mortality. Clinical and laboratory data, antimicrobial susceptibility, treatment, and Sequential Organ Failure Assessment (SOFA) score were evaluated as possible predictors of outcome. RESULTS: The 14-day mortality was 20% and there was no association between type of surgery and mortality. The SOFA score was the only independent predictor of 14-day mortality after adjustment for other variables. The calibration was acceptable (Hosmer-Lemeshow χ(2) = 3.65, p = 0.72) and the discrimination was good (area under the receiver operating characteristic curve: 0.80 ± 0.07, 95% confidence interval, 0.67-0.94). We found that a SOFA score ≥ 7 was a significant predictor of 14-day mortality in surgical patients with A baumannii bacteremia. CONCLUSIONS: The SOFA score assessed at the onset of bacteremia is a reliable tool for predicting 14-day mortality in surgical patients with A baumannii bacteremia.

Necrotizing fasciitis. Role of early surgical intervention.

OBJECTIVE: To evaluate our experience of management of necrotizing fasciitis (NF) particularly the role of early and aggressive surgical intervention. METHODS: This is a retrospective review of the cases affected by this disease and managed at Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, during 5 calendar years from 1996 through to 2000 (1416-1420 A.H). The preoperative and operative data was collected, and postoperative morbidity and mortality were analyzed. RESULTS: A total of 25 cases of NF were treated during the 5-year period, 18 were males and 7 female. The majority of patients had perianal suppuration as the primary lesion, followed by groin area in drug addicts and only 2 cases were primarily in the upper limbs. Diabetes and drug addiction were the main predisposing factors. All but 3 infections were polymicrobial, with streptococci and acinobacter being the most frequent organisms. The mainstay of treatment depends on a high index of suspicion, aggressive early and repeated debridements and adequate antibiotic coverage. The overall mortality was 24% but the drastic reduction in mortality was observed with early surgical intervention. CONCLUSION: The results highlight the role of early diagnosis; prompt and aggressive surgical debridements are critical for improved survival.

Replacement of infected thoracic aortic prosthesis with a spiral composite vein graft.

We describe a case of a patient who had a ruptured aorta repaired by femorofemoral bypass with an interposition graft and subsequently had a graft infection. The patient was taken to operation and the old graft was removed. It was replaced by a spiral great saphenous vein graft. The patient has been followed up for 36 months with computed tomographic scanning, which has shown that the vein graft has not dilated.

Surgical treatment of infected thoracic and abdominal aortic aneurysms.

Twelve patients with infected aneurysms of the thoracic and abdominal aorta were evaluated. Aneurysmal location, aetiology, bacteriology and treatment modality were analysed to determine the relationship between these factors and outcome. Patients were divided into two groups based on the preoperative states of their infections. Group 1 patients (n = 7) underwent resection after resolution of their active infection. The causative organisms included Staphylococcus epidermidis (two cases). Salmonella spp. (one). Acinetobacter (one), Mycobacterium tuberculosis (one) and unknown organisms (two). Group 2 patients (n = 5) required urgent surgery because of uncontrolled sepsis despite intensive treatment with antibiotics. The causative organisms included Staphylococcus aureus (two cases). Pseudomonas aeruginosa (two) and Salmonella spp. (one). In group 1, three patients underwent closed en bloc excision of the aneurysm with in-situ graft replacement, and four underwent partial resection with in-situ graft replacement. In group 2, three patients underwent resection of the aneurysm with ligation of aorta and extra-anatomic bypass, and two underwent in-situ graft replacement after débridement of infected tissue. Overall, patients in group 1 had a mortality rate of 14% compared with 80% in group 2. These results suggest that the operative approach and method chosen to restore arterial continuity have less of an impact on outcome. The primary determinants of outcome are virulence of the infecting organism and the preoperative state of the infection.

[Successful management of abdominal aortic aneurysm due to bacterial infection: report of a case].

A successful surgery of abdominal aortic aneurysm due to bacterial infection is described. The patient, 71-year-old man, had been suffering from high fever of unknown origin which had narrow escape with the several kinds of antibiotics about a month and more. During the antibiotic therapy in another hospital, he was diagnosed as an abdominal aortic aneurysm by whole body computed tomography. Immediately after the arrival to our hospital, digital subtraction angiography was done, and it showed a saccular aneurysm in the infrarenal abdominal aorta. Surgical removal of this aneurysm without opening of the aneurysmal wall was performed and the kitted dacron graft was used for aorto-biiliac anastomosis. The diagnosis of aneurysm due to bacterial infection was confirmed by bacteriological and pathological examinations. The patient in now surviving 17 months after operation. Abdominal aortic aneurysm due to bacterial infection is a serious disorder that generally carries grave prognosis. Complete removal of infected lesion without contamination and long-term follow-up with antibiotic chemotherapy are essential for this disease.