Specific distribution within the Enterobacter cloacae complex of strains isolated from infected orthopedic implants.

Bacteria belonging to the Enterobacter genus are frequently isolated from clinical samples but are unusual causative agents of orthopedic implant infections. Twelve genetic clusters (clusters I to XII) and one sequence crowd (sequence crowd xiii) can be distinguished within the Enterobacter cloacae nomenspecies on the basis of hsp60 sequence analysis, and until now, none of these clusters could be specifically associated with a disease. In order to investigate if specific genetic clusters would be involved in infections of orthopedic material, two series of bacterial clinical isolates identified as E. cloacae by routine phenotypic identification methods were collected either from infected orthopedic implants (n = 21) or from randomly selected samples of diverse anatomical origins (control; n = 52). Analysis of the hsp60 gene showed that genetic clusters III, VI, and VIII were the most frequent genetic clusters detected in the control group, whereas cluster III was poorly represented among the orthopedic implant isolates (P = 0.006). On the other hand, E. hormaechei (clusters VI and VIII), but not cluster III, is predominantly associated with infections of orthopedic implants and, more specifically, with infected material in the hip (P = 0.019). These results support the hypothesis that, among the isolates within the E. cloacae complex, E. hormaechei and hsp60 gene sequencing-based cluster III are involved in pathogenesis in different ways and highlight the need for more accurate routine Enterobacter identification methods.

Acute pancreatitis related to tigecycline: case report and review of the literature.

Tigecycline is a new broad-spectrum antibiotic. Nausea and vomiting are its most common side-effects. We describe here a case of severe acute pancreatitis related to tigecycline in order to highlight the possible occurrence of this adverse event and to remind clinicians to measure the lipase rate if in any doubt.

Positive effect of patient education for hip surgery: a randomized trial.

The current trial compared patient education before total hip arthroplasty with the usual verbal information. A randomized, controlled 24-month prospective single-center study was done. Patients scheduled for a first elective total hip arthroplasty for primary hip osteoarthritis were enrolled. All patients were given the usual information and an information leaflet and completed a self-evaluation questionnaire (Spielberger State and Trait Anxiety Inventory). The patients were assigned randomly to two groups: Group 1 attended a collective multidisciplinary information session 2 to 6 weeks before surgery and the control group did not attend. All patients completed another State Anxiety Inventory just before surgery and then 1 and 7 days after surgery. One hundred patients were randomized. Forty-eight attended the collective information session. Patients receiving education were significantly less anxious just before surgery than patients in the control group, in linear regression after adjustment for gender, trait and state anxiety at baseline, depression score, and health assessment questionnaire score. They experienced less pain before surgery and were able to stand sooner. However, the trend toward lower anxiety scores was not statistically significant after surgery. Patient education decreases preoperative anxiety and pain in patients having hip surgery.