Synchronous Pseudomonas Infection in Nose and Maxillery Sinus After Septorhinoplasty.

ABSTRACT: A 50-year-old patient who underwent secondary rhinoplasty 1 year after the operation presented with signs of localized infection on the postoperative twentieth day. An abscess due to Pseudomonas aeruginosa was detected in the nose and maxillary sinus. The infection regressed after surgical debridement combined with intravenous antibiotic therapy.Pseudomonas infection has been reported in only six patients after septorhinoplasty. Rhinoplasty was combined with other aesthetic procedures in three patients. The mean time of onset of complaints was 33.25 days. The most common complaint was pain. The mean time to complete regression of complaints after treatment was 44.5 days.Pseudomonas infection risk is especially increased in patients with combined surgical procedures and complicated revision rhinoplasty surgery. Careful examination of the patient, early and aggressive therapy, and surgical debridement are essential. The treatment of infection is incision and drainage of the affected areas. Antibiotic therapy followed by sensitivity-specific regimens should be administered."

The effects of silicone hydrogel lens wear on the corneal epithelium and risk for microbial keratitis.

Previous studies using animal models and human clinical trials have demonstrated that the use of low-oxygen-transmissible contact lens materials produce corneal epithelial surface damage resulting in increased Pseudomonas aeruginosa (PA) adhesion and raft-mediated internalization into surface corneal epithelial cells. These findings led to the testable clinical predictions that (1) microbial keratitis (MK) risk is expected to be the greatest during the first 6 months of wear; (2) there is no difference between 6 and 30 night extended wear; and (3) that wear of hyperoxygen-transmissible lenses would reduce the reported incidence of infection. Subsequent epidemiologic studies have confirmed the first two predictions; however, increased oxygen transmissibility with silicone hydrogel (SiHy) lens wear has not altered the overall incidence of MK. In this review, more recent clinical and basic studies that investigate epithelial alterations and bacterial adhesion to corneal epithelial cells after the wear of SiHy lenses with and without concomitant exposure to chemically preserved multipurpose solutions (MPS) will be examined. The collective results of these studies demonstrate that even in the absence of lens-related hypoxia, MPS induce ocular surface changes during SiHy lens wear that are associated with a pathophysiologic increase in PA adherence and internalization in the corneal epithelium, and therefore, predict a greater risk for PA-MK. In addition, new data supporting an interactive role for inflammation in facilitating PA adherence and internalization in the corneal epithelium will also be discussed.

Biological mesh for abdominal wall hernia synthetic mesh multidrug-resistant Pseudomonas aeruginosa infection: report of a case.

The use of biological mesh for the treatment of synthetic mesh-related infections in patients who undergo ventral hernia repair has been considered over the past few years. Removal of the infected synthetic mesh, which may be required in such cases, can result in recurring herniation. Biological implants have thus been recently used for the reconstruction of the existing defect. We herein present the case of a patient who developed multidrug-resistant Pseudomonas aeruginosa synthetic mesh infection following hernia repair, which was managed by the removal of the material and the application of a biological mesh in the contaminated area.

Rat silicone hydrogel contact lens model: effects of high- versus low-Dk lens wear.

OBJECTIVES: This study used a rat contact lens (CL) model to test if high- versus low-Dk lens wear caused changes in (1) conjunctival Langerhans cell (LC) number or location; (2) Bcl-2 expression; and (3) infection risk. METHODS: Female, Lewis rats wore a high- or low-Dk CL continuously for 2 weeks. Afterward, corneas were harvested and processed for ADPase activity to identify LCs, for immunostaining and for real time-polymerase chain reaction. Contact lens-wearing rats also were challenged with Pseudomonas aeruginosa by placing a bacterial-soaked CL on the eye followed by topical delivery of bacteria. After 48 hrs, slit lamp examination and real time-polymerase chain reaction were used to evaluate the corneal response. RESULTS: Conjunctival LC were significantly increased after low- versus high-Dk CL wear (P<0.0001). In contrast, conjunctival LC in non-lens wearing rats was not significantly different from the high-Dk lens wearing group. Bcl-2 mRNA levels were significantly decreased in low- versus high-Dk CL wearing rats, while Bax, FasL, caspase 3, and caspase 9 levels were unchanged. Immunostaining for Bcl-2 showed fewer positively stained epithelial cells in the low- versus high-Dk lens wearing group. After bacterial challenge, 30% of low- versus none of the high-Dk CL wearing corneas became infected and showed increased mRNA levels for several proinflammatory cytokines/chemokines, inducible nitric oxide synthase and matrix metalloproteinase-9. CONCLUSION: Low- versus high-Dk or non-CL wear led to an increased number of conjunctival LC, decreased Bcl-2 levels, and increased the risk of bacterial infection.

Mandibular osteomyelitis due to Pseudomonas aeruginosa. Case report.

Osteomyelitis is a relatively frequent bacterial infection of the jaw bones. This report describes a case of mandibular osteomyelitis in a surgical site after enucleation of a follicular cyst and extraction of the associated tooth. This case is unusual because maxillary osteomyelitis generally results from polymicrobial infection. In our patient, however, laboratory analysis identified Pseudomonas aeruginosa as the etiologic agent, an opportunistic pathogen normally found on moist surfaces and vegetation. Notorious for its antibiotic multiresistance, P. aeruginosa is increasingly recognized as a serious problem in hospitalized patients. Isolation of the responsible microbe permitted specific antibiotic treatment with a 10-day course of ciprofloxacin (250 mg/12 h), which fully cleared the infection.

Oral infection by Pseudomonas aeruginosa in patient with chronic kidney disease - a case report.

Chronic renal patients are more susceptible to hospital complications and infections such as urinary tract infections, peritonitis, surgery infections, and bacteremia, which are often caused by Pseudomonas aeruginosa. A case of a HIV-positive girl with chronic kidney disease and with serious oral lesions due to P. aeruginosa septic shock is presented. The patient showed necrotic lesions in the oral mucosa, pathological tooth mobility, bone loss, and hematogenous osteomyelitis in the maxilla. The patient was submitted to systemic antibiotic therapy based on screening culture and treatment of bone lesions by eliminating the causal agent and restoring health conditions. This case report is extremely important for health professionals, since the oral cavity can be affected by this pathogen or serve as a colonization site.

Infective complications after free flaps reconstruction in patients affected by head and neck cancer Our experience on 77 cases.

AIM: The success rates of free flaps in patients undergoing head and neck cancer (HNC) surgery are very high (95%- 97%) but the development of a surgical site infection (SSI) can put flap viability at risk. The aim of our study is to identify the risk factors for SSI in patients undergo free flaps reconstruction after head and neck cancer removal. MATERIAL OF STUDY: Seventyseven patients (44 male and 33 female) from April 2006 to April 2015 admitted at the Department of Maxillofacial Surgery of the University of Naples "Federico II" were included in this study. All the patients underwent free flap reconstruction for HNC. RESULTS: A microbiological analysis in 32 patients with signs of SSIs was performed, and 27 (35%) patients showed positive cul ture results, 5 patients were false positives. DISCUSSION: SSIs are one of the most common nosocomial infec tions that increase medical costs. HNC surgery frequently requires opening of the mouth floor, oropharynx, nasopharynx, or proximal esophagus, and these areas are likely to be contaminat ed by local microbiotics. Positive significant correlation between long operation timing and SSIs. CONCLUSION: Was observed the factors contributing to postoperative infections for patients affected by head and neck tumor. 35% of our study population devel oped an SSI (27/77). The most commonly discovered pathogen was MRSA (Methicillin-resistant Staphylococcus aureus). Were examinated sex, cardiovascular disease, blood loss more than 560 mL, and a long operation time ≥ 6 hours were significant risk factors for SSI. KEY WORDS: Free flaps, Head and neck cancer, Infective complications.

Polyanion-tobramycin nanocomplexes into functional microparticles for the treatment of Pseudomonas aeruginosa infections in cystic fibrosis.

AIM: Efficacy of antibiotics in cystic fibrosis (CF) is compromised by the poor penetration through mucus barrier. This work proposes a new 'nano-into-micro' approach, used to obtain a combinatorial effect: achieve a sustained delivery of tobramycin and overcome mucus barrier. METHODS: Mannitol microparticles (MPs) were loaded with a tobramycin polymeric nanocomplex and characterized in presence of CF artificial mucus. RESULTS & DISCUSSION: MPs are able to alter the rheological properties of CF artificial mucus, enhancing drug penetration into it and allowing a prolonged drug release. MPs resulted to be effective in Pseudomonas aeruginosa infections if compared with free tobramycin. CONCLUSION: MPs resulted to be a formulation of higher efficacy, with potential positive implications, as lower required dose, administration frequency, side effects and antibiotic resistance problems.

Therapeutic efficacy of three silver dressings in an infected animal model.

The organic salt AgNO3 has been available as a topical armamentarium to the medical arena for centuries and for burns for the past 60 years. Thirty-five (1968) years later, Charles Fox introduced and popularized a new topical agent known as silver sulfadiazine. More recently, several new slow-release silver dressings came to the forefront. Acticoat (Smith & Nephew, Largo, FL) Silverlon (Argentum, Lakemont, GA) & Silvasorb (Medline Industries, Inc, Mundelein, IL). Because the standard of care is to change dressings daily, our study focused in on weekly dressing changes as a cost-containment issue. Sprague-Dawley rats received a standard contact burn (20% TBSA). On day 3, the wound was excised and infected with Pseudomonas aeruginosa and Staphylococcus aureus at 5.0 x 10 cfu/ml. The animals were divided into four groups (n = 5 each group): untreated control, Acticoat group, Silvasorb group, and Silverlon group. The dressings remained on the wounds for 10 days when the wounds were quantitatively assessed. Mean wound counts of the control ranged from 1.2 x 10(5) to 6.5 x 10(5) for P. aeruginosa and S. aureus, respectively. Acticoat dressing counts for both organisms were 0 and 1.8 x 10(3) (median alpha); Silvasorb was 0 and 6.3 x 10(3) and Silverlon was 1.5 x 10(4) x 7.4 x 10(4) (median), Acticoat and Silvasorb were both significantly lower (P < .05) than the control for P. aeruginosa, and Acticoat was significantly lower (P < .05) than the control for S. aureus. Although counts for Silvasorb (M) appear significantly lower than the controls for S. aureus, the numbers were not sufficient to be significant. However, Silverlon did achieve a slight significance. These preliminary data suggest that weekly dressing changes with these new silver dressings are feasible and economically and medically congruous.

Rubbing skin with nylon towels as a major cause of pseudomonas folliculitis in a Japanese population.

Pseudomonas folliculitis (PF) is a community-acquired skin infection, which develops after exposure to contaminated water such as whirlpools, swimming pools, water slides and hot tubs. In Japan, this condition has been sporadically reported, often in association with bathing; however, the exact cause of PF in the Japanese population remains unclear. In this study, we retrospectively reviewed 10 patients with PF diagnosed at our dermatology clinic (two males and eight females). Four patients had recurrences over 1-3 years. Notably, eight of the 10 patients were rubbing their bodies with nylon towels or sponges placed in the bathrooms during bathing. Pseudomonas aeruginosa was isolated from the nylon towels used in two of the two patients examined. Discontinued use of nylon towels resulted in prompt resolution of PF and no recurrence in all cases. Our observation suggests that rubbing the skin with nylon towels contaminated with P. aeruginosa was a major cause of PF in a Japanese population.

Infective endocarditis and access site infections in patients on hemodialysis.

Infective endocarditis has been a subtle and very often lethal complication of hemodialysis. Thirty-five episodes have been described to date. Antecedent infections, particularly those involving the access site, access manipulation, and dental work appear to predispose to IE. Once IE is acquired, factors associated with mortality are involvement of two or more valves, infection caused by enterococci, antecedent infection, steroid therapy, infection in the first year post-access insertion and patient age over 46. The incidence of access infection with the arteriovenous fistula is significantly less than that associated with the arteriovenous cannula. Staphylococci are the most common organisms in access infections and in IE. Gram-negative bacilli and particularly Pseudomonas aeruginosa are a frequent cause of access infection but an unusual cause of IE. Access removal may be madatory in the successful management of IE in patients on hemodialysis.

Adhesion of Pseudomonas aeruginosa strains to untreated and oxygen-plasma treated poly(vinyl chloride) (PVC) from endotracheal intubation devices.

Pseudomonas aeruginosa pneumonia is a life threatening complication in mechanically ventilated patients that requires the ability of the bacteria to adhere to, and colonize the endotracheal intubation device. New strategies to prevent or reduce these nosocomial infections are greatly needed. We report here the study of a set of P. aeruginosa clinical isolates, together with specific mutants, regarding their adhesion on native and chemically modified poly(vinyl chloride) (PVC) surfaces from endotracheal intubation devices. The adhesion of the different strains to untreated PVC varied widely, correlating with several physico-chemical characteristics known to influence the attachment of bacteria to inert surfaces. The adhesion patterns were compared to the calculations obtained with the DLVO theory of colloidal stability. These results illustrate the importance of testing different clinical isolates when investigating bacterial adhesion. Oxygen plasma treatment of the PVC pieces yielded a hydrophilic surface and reduced the number of adhering bacteria by as much as 70%. This reduction is however unlikely to be sufficient to prevent P. aeruginosa colonization of endotracheal intubation devices.

Inhibition of bacterial adhesion on PVC endotracheal tubes by RF-oxygen glow discharge, sodium hydroxide and silver nitrate treatments.

Medical-grade poly(vinyl chloride) (PVC) was chemically modified to study how the incorporation of monovalent silver influences Pseudomonas aeruginosa adhesion and colonization. The modification investigated consisted of a radio frequency-oxygen (RF-O(2)) glow discharge pre-functionalization, followed by a two-step wet-treatment in sodium hydroxide and silver nitrate solutions. X-ray photoelectron spectroscopy (XPS) analysis and contact angle measurements were used to investigate the chemical nature and surface wettability of the films following each step of the modification. XPS analysis proved that the RF-O(2) plasma pre-functionalization of native PVC reproducibly increased the amount of functional groups representative of PVC additives, including ether/alcohol, esters and carboxyl groups. More specifically, we demonstrated that the O-C=O groups representative of the phthalic ester and zinc carboxylate additives identified for native PVC increased by two-fold following the RF-O(2) plasma pre-functionalization step. Although RF-O(2) pre-functionalization did not have an effect on the silver content of the NaOH/AgNO(3) treated substrates, such a modification was necessary for biomaterial products that did not have reproducible surfaces amongst production lots. XPS analysis also demonstrated that saponification with sodium hydroxide (NaOH) of esters, like those of the phthalic ester additives of PVC is a simple, irreversible method of hydrolysis, which produced sodium carboxylate and sodium phthalate salts. Exposure of native PVC to NaOH resulted in an increased surface hydrophilicity (from ca 90 degrees to ca 60 degrees ) due to dechlorination. XPS analysis following further incubation in silver nitrate demonstrated that silver ions can be trapped when the sodium of sodium carboxylate is replaced by silver after performing a second treatment with a monovalent silver-containing solution. The creation of silver salt on native PVC resulted in an ultra-hydrophobic (>120 degrees ) surface. The chemical modifications using NaOH and AgNO(3) wet treatments completely inhibited bacterial adhesion of four strains of P. aeruginosa to both native and oxygen-pre-functionalized PVC, and efficiently prevented colonization over longer periods (72 h). Our results suggest that surface modifications that incorporate silver ions would be extremely effective at reducing bacterial colonization to medical devices.

Pseudomonas aeruginosa infections associated with use of povidone-iodine in patients receiving continuous ambulatory peritoneal dialysis.

Fifteen episodes of infection due to Pseudomonas aeruginosa, including peritonitis and catheter site infections, occurred in nine patients receiving continuous ambulatory peritoneal dialysis over a 27-month period. Eight episodes were associated with catheter loss. Occurrence of P aeruginosa infection was significantly associated with use of povidone-iodine solution to cleanse the catheter site. There was no association with use of povidone-iodine solution to disinfect tubing connections, use of other skin care products or exposure to other environmental sources of P aeruginosa. Cultures of available povidone-iodine products were negative. Local irritation and alteration in skin flora caused by antiseptic solution or low-level contamination of povidone-iodine solution are potential mechanisms of infection.

Hematogenous infection of total knee implants.

Three cases of hematogenous infection of total knee replacement are reported. In two cases septicemia following cholecystectomy resulted in E. coli infection of the knee joint. Prophylactic antibiotic therapy of implant patients undergoing dental or surgical procedures is recommended.

Gastrointestinal colonization and septicaemia with Pseudomonas aeruginosa due to contaminated thymol mouthwash in immunocompromised patients.

An outbreak of septicaemia with Pseudomonas aeruginosa amongst adult men with haematological malignancy involved eight patients on the same ward during a period of 5 weeks. The strains isolated from blood cultures from seven patients were indistinguishable by conventional typing methods. Thymol mouthwash which had been made up and distributed in communal jugs was found to be contaminated with the epidemic strain and was the likely source for this outbreak. A high rate of gastrointestinal colonization with the epidemic strain was found in the patients receiving the contaminated mouthwash. Only those patients with prolonged severe leucopenia developed septicaemia. Communal medications are an unnecessary hazard, particularly in oncology wards.

Povidone-iodine (betadine) in the treatment of experimental Pseudomonas aeruginosa keratitis.

Topical 5% povidone-iodine for the treatment of corneal ulcers was observed in Sierra Leone, West Africa by one of us (D.J.D.). To test the efficacy of topical 5% povidone-iodine for infectious keratitis, experimental Pseudomonas aeruginosa keratitis was induced in 12 rabbits by first abrading the central 3 mm of corneal epithelium. Thirty milliliters of broth of P. aeruginosa strain ATCC 27835 (1.8 x 10(7) viable bacteria) was dropped twice on the wounded cornea. After 22 h, all corneas were clinically infected. Eight rabbits were treated with 5% povidone-iodine solution and four with 0.9% NaCl solution. All were given hourly drops. Twenty-four hours after treatment began, the central 8-mm button of the infected cornea was excised, homogenized, and serial dilutions plated onto MacConkey agar. The total number of viable Pseudomonas organisms was calculated. The treatment group had 5.2 +/- 0.4 CFUs (colony-forming units) per cornea. The control group had 4.8 +/- 0.4 CFUs per cornea (p = 0.11). The clinical scores (Hobden grading system) were 6.9 +/- 1.5 for the treated group and 7.3 +/- 2.5 for the control group (p = 0.74). There was no statistical difference between the treated and control groups. Povidone-iodine (5%) is not effective in the acute treatment of P. aeruginosa keratitis in this rabbit model.

Potentiation of infections by biomaterials: a comparison of three materials.

Biomaterial implants frequently potentiate infections in patients, yet rarely have we considered the interactions between bacteria and biomaterials responsible for this. There is extensive literature concerning suture materials of various types and a few studies comparing porous and solid implants. We have developed a simple, relatively atraumatic model for comparing rates of infection surrounding a biomaterial implant in paired single animal observations. Statistically significant differences between silicone and fluorocarbon implants and between silicone and bioglass implants are demonstrated. The relatively greater rate of infection with silicones is consistent with a previous clinical study. The further use of this model for evaluation of material-surface interfacial effects is proposed.