RESUMEN
INTRODUCTION: The objective of this study is to determine whether the deep tissues are inoculated during surgery with the Cutibacterium acnes still present in the skin after the surgical preparation in reverse shoulder arthroplasties. MATERIALS AND METHODS: Prospective study including patients undergoing surgery with reverse shoulder arthroplasty. All the patients received preoperative antibiotic prophylaxis with cefazolin (2 g IV) and the skin was prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. From all the patients, 9 cultures were obtained after the antibiotic was administrated and the skin surgically prepared. The cultures were sent to isolate C. acnes. DNA was extracted from the C. acnes isolated colonies. Isolate nucleotide distances were calculated using the Genome-based distance matrix calculator from the Enveomics collection toolbox. RESULTS: The study included 90 patients. C. acnes was isolated in 24 patients (26.6%) with a total of 61 positive cultures. There were 12 phylotype II, 27 IB and 22 IA. In 9 patients, C. acnes was present in both skin and deep tissues, and they constituted the sample to be studied by means of genomic analysis. In 7 out of the 9 patients, deep tissue samples clustered closer to at least one of its corresponding skin isolates when compared to the other independent bacterial ones. CONCLUSIONS: The C. acnes present in the skin at the beginning of the surgery are the same as those found in the deep tissues at the end of the surgery. This result strengthens the possibility that the C. acnes is delivered from the skin to the deep tissues.
Asunto(s)
Artroplastía de Reemplazo de Hombro , Infecciones por Bacterias Grampositivas , Articulación del Hombro , Humanos , Articulación del Hombro/cirugía , Estudios Prospectivos , Infecciones por Bacterias Grampositivas/prevención & control , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Piel , Propionibacterium acnes , Hombro/cirugíaRESUMEN
A 39-year-old man was presented with infective endocarditis caused by Abiotrophia defectiva. Transesophageal echocardiography revealed extensive vegetation and destruction extending from the aortic valve to the aortic-mitral curtain and mitral valve accompanied by severe regurgitation of the aortic and mitral valves. After removal of vegetation, double-valve replacement were performed with double patch and mechanical prosthesis using the manouguian procedure.
Asunto(s)
Endocarditis Bacteriana , Endocarditis , Infecciones por Bacterias Grampositivas , Implantación de Prótesis de Válvulas Cardíacas , Masculino , Humanos , Adulto , Infecciones por Bacterias Grampositivas/diagnóstico por imagen , Infecciones por Bacterias Grampositivas/cirugía , Infecciones por Bacterias Grampositivas/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/complicaciones , Endocarditis/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodosAsunto(s)
Artroplastía de Reemplazo de Hombro , Infecciones por Bacterias Grampositivas , Articulación del Hombro , Triclosán , Humanos , Clindamicina/uso terapéutico , Peróxido de Benzoílo/uso terapéutico , Piel/microbiología , Propionibacterium acnes , Peróxidos , Articulación del Hombro/cirugía , Articulación del Hombro/microbiología , Infecciones por Bacterias Grampositivas/prevención & control , Infecciones por Bacterias Grampositivas/cirugía , Hombro/cirugíaRESUMEN
We experienced a case of infective endocarditis caused by Abiotrophia defectiva in which aortic, mitral, and tricuspid valve surgery was performed. Even if blood cultures are negative, it is important to treat patients with endocarditis considering the possibility that some organisms are difficult to detect via conventional blood culture. Embolism is a complication that should not be overlooked in cases of infective endocarditis, particularly those caused by Abiotrophia defectiva, which tends to cause embolism. As the patient had splenic and cerebral infarction preoperatively, early surgical intervention was performed to prevent further embolisms, and the patient's postoperative course was excellent.
Asunto(s)
Abiotrophia , Endocarditis Bacteriana , Endocarditis , Infecciones por Bacterias Grampositivas , Endocarditis/complicaciones , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Infecciones por Bacterias Grampositivas/cirugía , HumanosRESUMEN
A 69-year-old woman was airlifted to the emergency department after awakening with angina, diaphoresis, and shortness of breath. She was found to have ST-elevation myocardial infarction with 100% occlusion of her left anterior descending artery, and aspiration thrombectomy was performed. Blood cultures confirmed Enterococcus faecalis bacteremia. Our team used a clinical tool to determine whether transesophageal echocardiography was warranted to investigate for infective endocarditis. The patient's transesophageal echocardiogram showed a large mobile vegetation on her mitral valve. Given the presence of infective endocarditis in the absence of known coronary artery disease, we determined that the patient had likely developed acute coronary syndrome from a septic embolus originating from her mitral valve vegetation. Further investigation for the source of the bacteremia revealed a perforation 20 cm from the anal verge at the rectosigmoid junction. After perforation repair, the patient became hypoxic and tachycardic with diffuse abdominal pain, guarding, rebound tenderness, and loss of pulse. Exploratory laparotomy revealed air in the mesentery consistent with extraperitoneal perforation of the rectum, and an end-colostomy was performed. Unfortunately, the patient subsequently died.
Asunto(s)
Bacteriemia , Endocarditis Bacteriana , Infecciones por Bacterias Grampositivas , Anciano , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/diagnóstico por imagen , Enterococcus faecalis , Femenino , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugíaRESUMEN
BACKGROUND: Preoperative skin preparations for total shoulder arthroplasty (TSA) are not standardized for Cutibacterium acnes eradication. Topical benzyl peroxide (BPO) and benzyl peroxide with clindamycin (BPO-C) have been shown to reduce the bacterial load of C acnes on the skin. Our aim was to investigate whether preoperative application of these topical antimicrobials reduced superficial colonization and deep tissue inoculation of C acnes in patients undergoing TSA. METHODS: In a prospective, single-blinded randomized controlled trial, 101 patients undergoing primary TSA were randomized to receive either topical pHisoHex (hexachlorophene [1% triclosan; sodium benzoate, 5 mg/mL; and benzyl alcohol, 5 mg/mL]) (n = 35), 5% BPO (n = 33), or 5% BPO with 1% clindamycin (n = 33). Skin swabs obtained prior to topical application and after topical application before surgery, as well as 3 intraoperative swabs (dermis after incision, on joint capsule entry, and dermis at wound closure), were cultured. The primary outcome was positive culture findings and successful decolonization. RESULTS: All 3 topical preparations were effective in decreasing the rate of C acnes. The application of pHisoHex reduced skin colonization by 50%, BPO reduced skin colonization by 73.7%, and BPO-C reduced skin colonization by 81.5%. The topical preparation of BPO-C was more effective in decreasing the rate of C acnes at the preoperative and intraoperative swab time points compared with pHisoHex and BPO (P = .003). Failure to eradicate C acnes with topical preparations consistently resulted in deep tissue inoculation. There was an increase in the C acnes contamination rate on the skin during closure (33%) compared with skin cultures taken at surgery commencement (22%). CONCLUSION: Topical application of BPO and BPO-C preoperatively is more effective than pHisoHex in reducing colonization and contamination of the surgical field with C acnes in patients undergoing TSA.
Asunto(s)
Artroplastía de Reemplazo de Hombro , Infecciones por Bacterias Grampositivas , Articulación del Hombro , Triclosán , Peróxido de Benzoílo , Clindamicina , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/prevención & control , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Incidencia , Peróxidos , Propionibacterium acnes , Estudios Prospectivos , Articulación del Hombro/cirugía , Piel/microbiologíaRESUMEN
BACKGROUND: Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. METHODS: Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. RESULTS: Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. CONCLUSION: In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Endocarditis Bacteriana/cirugía , Infecciones por Bacterias Grampositivas/cirugía , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/mortalidad , Enterococcus , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recurrencia , Reoperación/estadística & datos numéricos , Factores de Riesgo , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/mortalidad , Infecciones Estafilocócicas/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Parvimonas micra (P. micra) is a gram-positive anaerobic coccus that is detected widely on the skin, in the oral mucosa and in the gastrointestinal tract. In certain circumstances, P. micra can cause abdominal abscesses, bacteraemia and other infections. To the best of our knowledge, there have been no case reports describing the biological characteristics of P. micra-related pneumonia. These bacteria do not always multiply in an aerobic organ, such as the lung, and they could be easily overlooked because of the clinical mindset. CASE PRESENTATION: A 35-year-old pregnant woman was admitted to the emergency department 4 weeks prior to her due date who was exhibiting 5 points on the Glasgow coma scale. A computed tomography (CT) scan showed a massive haemorrhage in her left basal ganglia. She underwent a caesarean section and brain surgery before being admitted to the ICU. She soon developed severe pneumonia and hypoxemia. Given that multiple sputum cultures were negative, the patient's bronchoalveolar lavage fluid was submitted for next-generation sequencing (NGS) to determine the pathogen responsible for the pneumonia; as a result, P. micra was determined to be the causative pathogen. Accordingly the antibiotic therapy was altered and the pneumonia improved. CONCLUSION: In this case, we demonstrated severe pneumonia caused by the anaerobic organism P. micra, and the patient benefited from receiving the correct antibiotic. NGS was used as a method of quick diagnosis when sputum culture failed to distinguish the pathogen.
Asunto(s)
Firmicutes , Infecciones por Bacterias Grampositivas/complicaciones , Neumonía Bacteriana/microbiología , Complicaciones Infecciosas del Embarazo , Adulto , Antibacterianos/uso terapéutico , Cesárea , Coma/diagnóstico , Coma/microbiología , Coma/cirugía , Femenino , Firmicutes/aislamiento & purificación , Firmicutes/patogenicidad , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/microbiología , Hemorragias Intracraneales/cirugía , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/patología , Neumonía Bacteriana/cirugía , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/microbiología , Tercer Trimestre del Embarazo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
Fournier gangrene is a progressive necrotizing infection of the external genitalia or perineum that constitutes a urologic emergency. Incidence of Fournier gangrene is rising because of population aging, increasing comorbidities, and widespread use of immunosuppressive therapy, including immunosuppressive regimens used in kidney transplants. This is a rapidly progressive and potentially lethal disease without treatment, and early recognition of the disease, proper management of the predisposing factors, and aggressive surgical debridement are the most essential interventions. We report a rare case of Fournier gangrene in the early postoperative period of a kidney transplant due to a perinephric abscess.
Asunto(s)
Absceso Abdominal/microbiología , Gangrena de Fournier/microbiología , Trasplante de Riñón/efectos adversos , Perinefritis/microbiología , Complicaciones Posoperatorias/microbiología , Absceso Abdominal/cirugía , Anciano , Desbridamiento , Enterococcus faecalis/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/cirugía , Gangrena de Fournier/cirugía , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Masculino , Perinefritis/cirugía , Complicaciones Posoperatorias/cirugíaRESUMEN
With modern technology and peri-op antibiotic use, postoperative endophthalmitis is uncommon to modern cataract surgery, and its recurrence even more unusual. Enterococcal faecalis endophthalmitis is an acute type of endophthalmitis that is not only rare, but can be recurrent, and has a poor functional prognosis [1]. Since the disease is refractory to conventional therapy, this paper details our experience with treating the disease given the current lack of standard care both medically and surgically.
Asunto(s)
Remoción de Dispositivos , Endoftalmitis/cirugía , Enterococcus faecalis/aislamiento & purificación , Infecciones Bacterianas del Ojo/cirugía , Infecciones por Bacterias Grampositivas/cirugía , Lentes Intraoculares , Anciano , Antibacterianos/uso terapéutico , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Implantación de Lentes Intraoculares , Microscopía Acústica , Facoemulsificación , Recurrencia , Microscopía con Lámpara de Hendidura , Vancomicina/uso terapéutico , Agudeza Visual/fisiología , Cuerpo Vítreo/microbiologíaAsunto(s)
Endocarditis Bacteriana , Infecciones por Bacterias Grampositivas , Trasplante de Corazón , Prótesis Valvulares Cardíacas , Infecciones Relacionadas con Prótesis , Endocarditis Bacteriana/cirugía , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/cirugía , Trasplante de Corazón/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Válvulas Cardíacas , Humanos , Propionibacterium acnes , Infecciones Relacionadas con Prótesis/diagnósticoRESUMEN
Infectious endocarditis (IE) remains one of the deadliest heart diseases with a high death rate, generally following thrombo-embolic events. Today, therapy is based on surgery and antibiotic therapy. When thromboembolic complications in IE patients persist, this is often due to our lack of knowledge regarding the pathophysiological development and organization of cells in the vegetation, most notably the primordial role of platelets and further triggered hemostasis, which is related to the diversity of infectious microorganisms involved. Our objective was to study the organization of IE vegetations due to different bacteria species in order to understand the related pathophysiological mechanism of vegetation development. We present an approach for ultrastructural analysis of whole-infected heart valve tissue based on scanning electron microscopy and energy-dispersive X-ray spectroscopy. Our approach allowed us to detect differences in cell organization between the analyzed vegetations and revealed a distinct chemical feature in viridans Streptococci ones. Our results illustrate the benefits that such an approach may bring for guiding therapy, considering the germ involved for each IE patient.
Asunto(s)
Endocarditis Bacteriana/diagnóstico por imagen , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/diagnóstico por imagen , Válvulas Cardíacas/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Plaquetas , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/patología , Endocarditis Bacteriana/cirugía , Femenino , Fibrina/análisis , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/patología , Infecciones por Bacterias Grampositivas/cirugía , Válvulas Cardíacas/microbiología , Válvulas Cardíacas/patología , Válvulas Cardíacas/cirugía , Humanos , Inflamación/diagnóstico por imagen , Inflamación/microbiología , Masculino , Microscopía Electrónica de Rastreo/métodos , Persona de Mediana Edad , Espectrometría por Rayos X/métodosRESUMEN
BACKGROUND: Vascular reconstruction is required to treat infectious intracranial aneurysms (IIAs) on arteries supplying the eloquent area. However, extracranial-intracranial bypass is sometimes impossible because IIAs are frequently located distally on arteries and the length of a donor artery is limited. We report a rare case of an unruptured Gemella morbillorum IIA, which was successfully treated by intracranial-intracranial (IC-IC) bypass using a Y-shaped superficial temporal artery (STA) interposition graft. CASE DESCRIPTION: A 52-year-old man presented with heart failure and an unruptured IIA in the right anterior parietal artery because of acute G. morbillorum endocarditis. The patient was treated with urgent replacement of cardiac valves and antibiotic therapy. However, the IIA increased in size during the following 1 month, and therefore was treated surgically to prevent the rupture. End-to-side IC-IC bypass using a Y-shaped STA graft followed by aneurysmal trapping was performed to overcome the limited length of the STA as a donor artery to prevent cerebral ischemia in the artery territory and to avoid direct injury to the sensory cortex adhering tightly to the IIA. Postoperative courses were uneventful, and he recovered from the infectious diseases. CONCLUSIONS: This case suggests that end-to-side IC-IC bypass using a Y-shaped STA graft can be a good option for surgical treatment of IIAs, which are located in eloquent areas.
Asunto(s)
Aneurisma Infectado/cirugía , Prótesis Vascular , Revascularización Cerebral/métodos , Gemella/aislamiento & purificación , Infecciones por Bacterias Grampositivas/cirugía , Aneurisma Intracraneal/cirugía , Aneurisma Infectado/diagnóstico por imagen , Infecciones por Bacterias Grampositivas/diagnóstico por imagen , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Corteza Sensoriomotora/irrigación sanguínea , Corteza Sensoriomotora/diagnóstico por imagen , Corteza Sensoriomotora/cirugíaRESUMEN
The use of ampicillin in the outpatient setting has traditionally been avoided because of the short half-life and instability in solution of this drug. However, recent in vitro data and two case series support the safe and effective administration of ampicillin by continuous infusion in the community. Therapeutic drug monitoring (TDM) of beta-lactam antibiotics can be used to optimise antibiotic exposure and ensure adequate clinical responses. A case series is presented of patients receiving ampicillin via prolonged infusion in the outpatient setting, with TDM to ensure adequate plasma antibiotic levels were achieved. Three patients who received ampicillin by continuous infusion under the Outpatient Parenteral Antimicrobial Therapy (OPAT) program are described, including details of antibiotic dose and steady-state plasma drug concentration as measured by high-performance liquid chromatography. All three patients had an infection with ampicillin-susceptible Enterococcus faecalis; one patient had post-partum endometritis, one had urosepsis and one had a complex polymicrobial bone and joint infection. Adequate plasma drug levels were achieved in all patients. Management of the antibiotic temperature and infusion times, and appropriate timing of drug levels in the community were required. Two patients achieved clinical cure, while the third required further surgical debridement and antibiotic therapy. TDM in this setting enabled the contemporaneous management and dose alteration of ampicillin. Ampicillin may be a safe and effective drug when administered by continuous infusion with appropriate TDM in the community setting.
Asunto(s)
Ampicilina/administración & dosificación , Antibacterianos/administración & dosificación , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Adulto , Anciano , Monitoreo de Drogas , Endometritis/diagnóstico , Endometritis/tratamiento farmacológico , Enterococcus faecalis/efectos de los fármacos , Femenino , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Infusiones Parenterales/métodos , Masculino , Pacientes Ambulatorios , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
An adult female spotted eagle ray (Aetobatus narinari) presented for medical evaluation due to a swelling located on the dorsal head. Ultrasound revealed that the swelling originated from a large pocket of fluid in the cranial vault. The swelling was aspirated, and purulent discharge was obtained; Enterococcus faecalis was cultured. An incision was made over the swelling in an attempt to drain fluid but was unsuccessful. Multiple aspirates were performed to drain the abscess, and the animal was treated with oxytetracycline injections. The initial incision sloughed and resulted in a large defect in the cranium that allowed exhibit water to come into the cranial vault and come in contact with the protective membrane of the brain. Forty-two days after initial presentation, the defect in the cranium was healed; fluid from the cranial vault was sampled and appeared normal. During and after treatment, the ray exhibited no abnormal neurologic signs.
Asunto(s)
Enterococcus faecalis/fisiología , Enfermedades de los Peces/diagnóstico , Enfermedades de los Peces/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/veterinaria , Rajidae , Animales , Enterococcus faecalis/efectos de los fármacos , Femenino , Enfermedades de los Peces/cirugía , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/cirugía , Cráneo/microbiología , Cráneo/cirugía , Resultado del TratamientoRESUMEN
Nasal tip abscesses in children are uncommon. We report on 7 children/teenagers who presented with an advanced nasal tip abscess that required intravenous antibiotics and surgical drainage, despite adequate pre-admission antibiotic therapy with amoxicillin/clavulanic acid or cephalosporins. Cultures were positive for Staphylococcus aureus, that was clindamycin-resistant but TMP/SMX sensitive.
Asunto(s)
Absceso , Antibacterianos/uso terapéutico , Drenaje/métodos , Infecciones por Bacterias Grampositivas , Enfermedades Nasales , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Absceso/tratamiento farmacológico , Absceso/microbiología , Absceso/cirugía , Adolescente , Niño , Farmacorresistencia Bacteriana , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Masculino , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Nasales/microbiología , Enfermedades Nasales/cirugía , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugía , Staphylococcus aureus/aislamiento & purificación , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/cirugía , Streptococcus pyogenes/aislamiento & purificaciónRESUMEN
Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.Methods: Case report with orbital imaging.Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.
Asunto(s)
Blefaroptosis/microbiología , Diplopía/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Implantes Orbitales/microbiología , Propionibacterium acnes , Infecciones Relacionadas con Prótesis/microbiología , Blefaroptosis/cirugía , Remoción de Dispositivos , Diplopía/cirugía , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fracturas Orbitales/cirugía , Infecciones Relacionadas con Prótesis/cirugía , SiliconasRESUMEN
BACKGROUND: Cutibacterium are the most common cause of periprosthetic shoulder infections, as defined by ≥2 deep cultures. Established Cutibacterium periprosthetic infections cannot be resolved without prosthesis removal. However, the decision for implant removal must be made from an assessment of infection risk before the results of intraoperative cultures are finalized. We hypothesized that the risk for a Cutibacterium infection is associated with characteristics that are available at the time of revision arthroplasty. METHODS: In a retrospective review of 342 patients having prosthetic revisions between 2006 and 2018 for whom definitive deep culture results were available, we used univariate and multivariate analyses to compare the preoperative and intraoperative characteristics of 101 revisions with Cutibacterium periprosthetic infections to the characteristics of 241 concurrent revisions not meeting the definition of infection. RESULTS: Patients with definite Cutibacterium periprosthetic infections were younger (59 ± 10 vs. 64 ± 12, P < .001), were more likely to be male (91% vs. 44%, P < .001), were more likely to have had their index procedure performed for primary osteoarthritis (54% vs. 39%, P = .007), were more likely to be taking testosterone supplements (8% vs. 2%, P = .02), had lower American Society of Anesthesiologists scores (1.9 ± 0.7 vs. 2.3 ± 0.7, P < .001), and had lower body mass indices (29 ± 5 vs. 31 ± 7, P = .005). Patients with definite Cutibacterium periprosthetic infections also had significantly higher preoperative loads of Cutibacterium on their unprepared skin surface (1.7 ± 0.9 vs. 0.4 ± 0.8, P < .001) and were more likely to have the surgical finding of synovitis (41% vs. 16%, P < .001). CONCLUSIONS: The risk of definite Cutibacterium periprosthetic infections is associated with observations that can be made before or at the time of revision arthroplasty.
Asunto(s)
Artroplastía de Reemplazo de Hombro/efectos adversos , Infecciones por Bacterias Grampositivas/cirugía , Propionibacteriaceae/aislamiento & purificación , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Andrógenos/administración & dosificación , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/cirugía , Reoperación , Estudios Retrospectivos , Factores Sexuales , Piel/microbiología , Sinovitis/microbiología , Sinovitis/cirugía , Testosterona/administración & dosificaciónRESUMEN
A 5-year-old girl was referred to our institution with complaints of right hip pain and fever (39.0°C); blood tests and magnetic resonance imaging (MRI) were performed. Blood biochemical results revealed a high inflammatory reaction. MRI results revealed inflammation in the hip joint. She was diagnosed with pediatric septic arthritis of the hip, which required arthrotomy and lavage drainage. Treatment with intravenous vancomycin was initiated on the assumption that the causative bacterial species was Staphylococcus aureus. However, Group A Streptococcus pyogenes (GAS) was subsequently isolated from an intraoperative sample, and the antimicrobial agent was switched to aminobenzylpenicillin (ABPC). Clindamycin (CLDM) was added to the treatment regimen 14 days after surgery as MRI indicated the development and spread of osteomyelitis. Three months post-surgery, MRI findings indicated that the osteomyelitis had resolved and antimicrobial therapy was discontinued. To prevent the spread of osteomyelitis, a combination of CLDM and ABPC should be considered at an early stage, particularly in pediatric patients with GAS-induced septic arthritis.
Asunto(s)
Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Clindamicina/uso terapéutico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Cadera/microbiología , Osteomielitis/tratamiento farmacológico , Antibacterianos/administración & dosificación , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/cirugía , Preescolar , Clindamicina/administración & dosificación , Femenino , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/cirugía , Cocos Grampositivos/efectos de los fármacos , Cocos Grampositivos/aislamiento & purificación , Cadera/diagnóstico por imagen , Cadera/cirugía , Humanos , Imagen por Resonancia Magnética , Osteomielitis/diagnóstico , Osteomielitis/cirugíaRESUMEN
BACKGROUND: The local infectious origin and the putative role of Cutibacterium acnes (CA) of a particular subtype of discopathy (Modic 1) are still debated. PURPOSE: To establish the association of CA in intervertebral disc (IVD) and Modic 1 discopathy in patients with low back pain. METHODS: The prevalence of bacteria in IVD samples obtained by anterior approach in patient with chronic low back pain harboring Modic type 1, 2 or no Modic changes was compared to that measured in IVD samples obtained by posterior approach for sciatica. From 45 patients included in the study, 77 discs samples were obtained: 58 by anterior approach (32 Modic 1/2 changes, 26 without Modic change) and 19 by posterior approach. Conventional microbial cultures, universal 16S rRNA molecular detection and a CA specific PCR were performed. RESULTS: 12 /77 (15.6%) disc samples were culture positive. Among the 10 CA positive cultures, 5 out of 58 (8.6%) were identified from specimens obtained by anterior approach and 5/19 (26.3%) from posterior approach (p = 0.046). Moreover, the percentage of CA culture positive sample was statistically no different between the patient with or without Modic changes. The CA prevalence was lower through molecular, culture-free approaches: the universal 16S rRNA PCR was positive for 6 specimens, including one CA positive sample and the CA specific PCR was positive for one specimen obtained by posterior approach. CONCLUSIONS: In spine surgery the prevalence of CA in culture was significantly higher in IVD samples collected through a posterior approach compared to an anterior approach, suggesting a contamination process. This study did not support the CA related local infectious origin of Modic 1 discopathy.