Renal abscess caused by a Providencia stuartii isolate biochemically misidentified as Pasteurella.

Providencia stuartii is associated with urinary tract infection (UTI) in catheterized patients. Here we report an abscess containing P. stuartii in a patient with a history of UTI, renal stones, and stent placement. This organism was identified by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and 16S rRNA gene sequencing following biochemical identification as Pasteurella.

Multistate outbreak of Pseudomonas fluorescens bloodstream infection after exposure to contaminated heparinized saline flush prepared by a compounding pharmacy.

BACKGROUND: Pharmaceutical compounding, the manipulation of ingredients to create a customized medication, is a widespread practice. In January 2005, the Centers for Disease Control and Prevention was notified of 4 cases of Pseudomonas fluorescens bacteremia that were traced to contaminated heparinized saline intravenous flush syringes prepared as a compounded medical product. PATIENTS AND METHODS: We reviewed medical records of symptomatic patients with P. fluorescens-positive cultures of blood specimens or sections of explanted catheters, reviewed the production process of syringes, performed syringe cultures, compared isolates by pulsed-field gel electrophoresis (PFGE), and examined catheters by scanning electron microscopy. RESULTS: We identified 80 patients in 6 states with P. fluorescens-positive cultures during December 2004-March 2006. Sixty-four patients (80%) had received a diagnosis of cancer. Seventy-four (99%) of 75 patients for whom information about catheter type was available had long-term indwelling catheters. Thirty-three (41%) of 80 cases were diagnosed 84-421 days after the patient's last potential exposure to a contaminated flush (delayed-onset cases). Compared with patients with early infection onset, more patients with delayed infection onset had venous ports (100% versus 50%; P <.001). By PFGE, clinical isolates from 50 (98%) of 51 patients were related to isolates cultured from unopened syringes. Scanning electron microscopy of explanted catheters revealed biofilms containing organisms morphologically consistent with P. fluorescens. CONCLUSION: This outbreak underscores important challenges in ensuring the safety of compounded pharmaceuticals and demonstrates the potential for substantially delayed infections after exposures to contaminated infusates. Exposures to compounded products should be considered when investigating outbreaks. Patients exposed to contaminated infusates require careful follow-up, because infections can occur long after exposure.

A retained sponge is a complication of vacuum-assisted closure therapy.

Vacuum-assisted closure (VAC) system has become a widely used, efficacious, and overall safe method for managing many types of open wounds. The authors present a case of a rare but avoidable complication caused by a retained piece of sponge after VAC therapy (KCI Inc, San Antonio, TX). They emphasize the need for awareness and careful evaluation of the patient who receives VAC therapy to avoid diagnostic confusion and morbidity to the patient.

Group G Streptococcus spinal epidural abscess: case report and review of the literature.

Group G streptococci have been identified as a recently emerging pathogen. Spinal epidural abscess is an infrequent but well described infection of the central nervous system that may present with non-specific clinical symptoms and physical examination findings. Group G streptococci are a rare cause of spinal epidural abscess that should be considered in the clinical picture so that appropriate therapy can be initiated in a timely fashion.

Halo pin insertion-associated brain abscess: case report and review of literature.

STUDY DESIGN: A case report of a patient with a halo pin-associated brain abscess and a review of literature. OBJECTIVES: To report a rare complication of halo pin insertion-associated brain abscess, and to discuss the diagnostic and treatment approach to its management. SUMMARY OF BACKGROUND DATA: Halo orthosis is a commonly used, well-tolerated spinal stabilizing device. However, on rare occasions, it can penetrate the inner table of the cranium, resulting in abscess formation that needs to be investigated urgently and treated promptly. METHODS: A 23-year-old male sustained a C2 vertebral fracture from a motor vehicular accident and was placed in halo traction. Two and a half months later, he noted loosening of the right occipital halo pin, which was tightened in the clinic. Fourteen days after pin tightening, he developed right-sided headaches, and it was decided to remove the halo traction. After the halo removal, the patient noted purulent discharge from the right occipital pin site, worsening headache, and associated nausea and vomiting. Magnetic resonance imaging of the brain demonstrated a right parietal lobe abscess and a sinus tract extending through the overlying calvarium. The patient underwent an evacuation of the abscess, and the culture was positive for methicillin-resistant Staphylococcus aureus. The patient was treated with intravenous vancomycin for 6 weeks. RESULT: The patient reported mediated improvement after surgery and on a follow-up visit was doing well without any neurologic sequelae. CONCLUSION: Halo pin-associated brain abscess is a rare but extremely important complication requiring prompt diagnosis and immediate intervention. Halo pin loosening with signs of local infection, fever, headaches, or seizures needs to be investigated urgently with neuroimaging. We conclude that with early diagnosis and appropriate treatment, serious morbidity and mortality can be avoided.

Cat scratch disease causing hepatic masses after liver transplant.

Hepatic cat scratch disease is rarely reported in liver transplant recipients and has never been reported with discrete liver lesions in the graft. A 52-year-old woman was transplanted for hepatitis C cirrhosis and hepatocellular carcinoma. Her posttransplant course was uneventful. She presented 2.7 years after transplantation with fever of unknown origin and went on to develop multiple and diffuse discrete liver lesions. Despite an extensive work-up including percutaneous and laparoscopic biopsies, a subsegmental resection that included one of these masses was required to make the diagnosis of Bartonella henselae infection. Serologic tests were equivocal. Histology was consistent with cat scratch disease of the liver, and polymerase chain reaction (PCR) testing of the resected tissue confirmed the diagnosis. Response to doxycycline was rapid. Fevers resolved within 7 days. Repeat abdominal CT scan showed reduction of the liver masses. Cat scratch disease should be considered in postliver transplant patients presenting with fever and liver lesions, especially if close contact with cats has occurred. Diagnosis by PCR testing of involved tissue is preferred when serologies are equivocal due to immunosuppression.