Asunto(s)
Cuerpos Extraños/microbiología , Hongos , Obstrucción Nasal/microbiología , Pólipos Nasales/microbiología , Femenino , Cuerpos Extraños/complicaciones , Humanos , Seno Maxilar/microbiología , Seno Maxilar/patología , Ilustración Médica , Persona de Mediana Edad , Pólipos Nasales/complicacionesAsunto(s)
Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/fisiopatología , Infecciones por Escherichia coli/cirugía , Gastritis/diagnóstico , Gastritis/cirugía , Infecciones Intraabdominales/diagnóstico , Infecciones Intraabdominales/cirugía , Alcoholismo/complicaciones , Alcoholismo/microbiología , Antidepresivos/efectos adversos , Resultado Fatal , Femenino , Cuerpos Extraños/microbiología , Gastritis/fisiopatología , Humanos , Infecciones Intraabdominales/fisiopatología , Persona de Mediana EdadRESUMEN
BACKGROUND: Owing to patient intolerance or drug interactions, alternative agents to rifampin are needed for management of staphylococcal periprosthetic joint infection. In the current study, we evaluated rifabutin, rifapentine and rifampin, with and without vancomycin, in a rat model of foreign body osteomyelitis. METHODS: Proximal tibiae were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) and a Kirschner wire (K-wire) implanted in each. After 4 weeks of infection, rifampin, rifabutin, or rifapentine were administered, alone or with vancomycin. Tibiae and K-wires were cultured, and medians were reported as log10 colony-forming units (CFUs) per gram of bone or log10 CFUs per K-wire, respectively. RESULTS: Rifampin, rifabutin or rifapentine administered with vancomycin yielded less MRSA from bones (0.10, 3.02, and 0.10 log10 CFUs/g, respectively) than did no treatment (4.36 log10 CFUs/g) or vancomycin alone (4.64 log10 CFUs/g) (both Pâ ≤â .02). The K-wires of animals receiving no treatment or vancomycin monotherapy recovered medians of 1.76 and 2.91 log10 CFUs/g per K-wire, respectively. In contrast, rifampin, rifabutin and rifapentine administered with vancomycin yielded medians of 0.1 log10 CFUs per K-wire, respectively. Rifampin resistance was detected in a single animal in the rifampin monotherapy group. CONCLUSIONS: Rifabutin or rifapentine with vancomycin were as active as rifampin with vancomycin against MRSA in rat foreign body osteomyelitis, suggesting that rifabutin and/or rifapentine may be alternatives to rifampin in the clinical management of staphylococcal periprosthetic joint infections.
Asunto(s)
Antibacterianos/uso terapéutico , Cuerpos Extraños/microbiología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Osteomielitis/microbiología , Rifabutina/uso terapéutico , Rifampin/análogos & derivados , Infecciones Estafilocócicas/tratamiento farmacológico , Animales , Modelos Animales de Enfermedad , Quimioterapia Combinada , Cuerpos Extraños/complicaciones , Masculino , Osteomielitis/etiología , Ratas , Ratas Wistar , Rifampin/administración & dosificación , Rifampin/uso terapéutico , Infecciones Estafilocócicas/etiología , Vancomicina/administración & dosificación , Vancomicina/uso terapéuticoAsunto(s)
Aspergilosis/diagnóstico , Aspergillus , Endoscopía , Cuerpos Extraños/diagnóstico , Enfermedades de los Senos Paranasales/diagnóstico , Aspergilosis/microbiología , Aspergilosis/patología , Diagnóstico Diferencial , Femenino , Cuerpos Extraños/microbiología , Cuerpos Extraños/patología , Humanos , Seno Maxilar/microbiología , Seno Maxilar/patología , Ilustración Médica , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/microbiologíaRESUMEN
Background: Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from patients with SSIs after spinal procedures is controversial. Moreover, primary spinal infections such as spondylodiscitis may require instrumentation along with surgical debridement. The purpose of this article was to evaluate critically and summarize the available evidence related to retention of hardware in patients with deep SSIs, and the use of instrumentation in surgical treatment of primary spinal infections. Methods: A literature search utilizing PubMed database was performed. Studies reporting the management of deep SSIs after instrumented spinal procedures, and of primary spinal infections using instrumentation published in peer-reviewed journals were included. Identified publications were evaluated for relevance, and data were extracted from the studies deemed relevant. Results: Because SSIs occur typically during the early post-operative period before stable bony fusion has been achieved, the removal of instrumentation may be associated with instability of the spinal column, pseudarthrosis, progressive deformity, pain, loss of function, and deterioration in the activities of daily living (ADL). Hence, early SSIs after spinal instrumentation are usually treated without removal of hardware. Moreover, primary spinal infections such as spondylodiscitis may require surgical debridement and instrumentation in cases with associated instability. Conclusions: Retaining or using instrumentation in patients with SSIs after spinal procedures or in patients with primary spinal infections, respectively, are commonly practiced in the field of spine surgery. Further evidence is required for the development of definitive algorithms to guide spine surgeons in decision making regarding the fate of instrumentation in the treatment of spinal infections.
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Cuerpos Extraños/cirugía , Fijadores Internos/microbiología , Columna Vertebral/cirugía , Infección de la Herida Quirúrgica/cirugía , Actividades Cotidianas , Antibacterianos/uso terapéutico , Desbridamiento/efectos adversos , Desbridamiento/métodos , Cuerpos Extraños/microbiología , Humanos , Estudios Retrospectivos , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/terapia , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/tratamiento farmacológico , Factores de TiempoAsunto(s)
Cementos para Huesos/efectos adversos , Absceso Epidural/microbiología , Cuerpos Extraños/microbiología , Metilmetacrilato/efectos adversos , Complicaciones Posoperatorias/microbiología , Adulto , Craneotomía/efectos adversos , Fracturas Conminutas/cirugía , Seno Frontal/lesiones , Seno Frontal/microbiología , Seno Frontal/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Ilustración Médica , Tomografía Computarizada por Rayos XRESUMEN
A 46-year-old immunosuppressed patient presented with a breast implant-associated infection 10 years after breast augmentation in Southeast Asia. No pathogen was identified in the initial conventional microbiological workup. Subsequently, infection with Mycobacterium abscessus-a nontuberculous mycobacteria-was diagnosed using a special culture technique. Increased rates of such infections are reported after cosmetic surgery in foreign countries, presumably due to inoculation with these ubiquitous pathogens. This case highlights the fact that the differential diagnosis and thus the microbiological workup should be extended in cases without initial pathogen detection.
Asunto(s)
Implantes de Mama/efectos adversos , Cuerpos Extraños/microbiología , Mastodinia/etiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Micobacterias no Tuberculosas/aislamiento & purificación , Infecciones Relacionadas con Prótesis/microbiología , Infección de la Herida Quirúrgica/microbiología , Implantes de Mama/microbiología , Fiebre/etiología , Humanos , Huésped Inmunocomprometido , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/microbiologíaRESUMEN
This case report outlines the presentation and management of a young soldier who sustained a lower limb acacia thorn injury while on exercise in Kenya. The injury failed to heal with a subsequent ultrasound scan revealing a large retained thorn requiring surgical removal and wash out. From this case, lessons can be learnt regarding the management of thorn injuries, which are common in exercising troops in Kenya and indeed around the world. The key take-home messages are always consider a retained thorn if wounds fail to settle, use ultrasound as the imaging modality of choice, always remove identified retained thorns and if antibiotics are required use broad-spectrum antibiotics pending culture results.
Asunto(s)
Acacia , Cuerpos Extraños , Componentes Aéreos de las Plantas/efectos adversos , Heridas Penetrantes , Adulto , Antiinfecciosos/uso terapéutico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/etiología , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/etiología , Cuerpos Extraños/microbiología , Cuerpos Extraños/cirugía , Fusariosis/tratamiento farmacológico , Fusariosis/etiología , Humanos , Masculino , Heridas Penetrantes/etiología , Heridas Penetrantes/microbiología , Heridas Penetrantes/patología , Heridas Penetrantes/terapia , Adulto JovenRESUMEN
Heart transplantation (HTx) represents the "gold standard" in end-stage heart failure therapy. Due to their severe heart failure and for prevention of sudden cardiac death, the majority of patients presenting for HTx will have a history of an implanted cardioverter-defibrillator (ICD). Usually, within the scope of HTx, all cardiac-implanted electronic device components are removed. In rare cases these efforts fail and some material remains. The abandoned lead fragments can cause serious complications. The case presented herein involves a patient with recurrent bacteremia after successful HTx originating from an abandoned and infected lead fragment. In 2016, a 64-year-old man received a donor heart transplant due to end-stage heart failure. Unfortunately, during the procedure, not all components of an ICD implanted in 2007 could be removed. An initially event-free period was followed by recurrent fever attacks and staphylococcal bacteremia was diagnosed. After an extensive search, the source of the bacteremia was identified by positron emission tomography-computed tomography (PET-CT), and percutaneous extraction of the abandoned and infected ICD lead fragment was scheduled. The fragment was extracted using a minimally invasive approach via percutaneous femoral vein access. The patient was discharged 3 days later, with no further complications. This case highlights the need for conscientious and complete removal of foreign material in the HTx setting. Difficult-to-diagnose sources of infection could be reliably identified by PET-CT. When required, extraction of the foreign body should be done using a minimally invasive approach.
Asunto(s)
Bacteriemia/etiología , Desfibriladores Implantables/efectos adversos , Cuerpos Extraños/complicaciones , Trasplante de Corazón , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/microbiología , Humanos , Masculino , Errores Médicos , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico por imagen , Staphylococcus aureusRESUMEN
Although much work is being done to develop new treatments, research and knowledge regarding factors underlying implant-related microbial colonization leading to infection are less comprehensive. Presence of microorganisms in and around implants clinically characterized as uninfected remains unknown. The objective of this study was to detect and identify bacteria and fungi on implants from various groups of patients with no prior indications of implant related infections. Patient samples (implants and tissue) were collected from five different hospitals in the Capital region of Denmark. By in-depth microbiological detection methods, we examined the prevalence of bacteria and fungi on 106 clinically uninfected implants from four patient groups (aseptic loosening, healed fractures, craniofacial complications and recently deceased). Of 106 clinically uninfected implants and 39 negative controls investigated, 66% were colonized by bacteria and 40% were colonized by fungi (p < 0.0001 compared to negative controls). A large number of microbes were found to colonize the implants, however, the most prevalent microbes present were not common aetiological agents of implant infections. The findings indicate that implants provide a distinct niche for microbial colonization. These data have broad implications for medical implant recipients, as well as for supporting the idea that the presence of foreign objects in the body alters the human microbiome by providing new colonization niches.
Asunto(s)
Bacterias/aislamiento & purificación , Cuerpos Extraños/microbiología , Hongos/aislamiento & purificación , Prótesis e Implantes/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/clasificación , Técnicas de Tipificación Bacteriana , Regeneración Ósea/fisiología , Estudios de Casos y Controles , Femenino , Fracturas Óseas/microbiología , Fracturas Óseas/cirugía , Hongos/clasificación , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Tipificación Micológica , Falla de PrótesisAsunto(s)
Dispositivos para el Autocuidado Bucal , Cuerpos Extraños/complicaciones , Absceso Piógeno Hepático/etiología , Estómago/lesiones , Heridas Penetrantes/complicaciones , Cuerpos Extraños/microbiología , Humanos , Absceso Piógeno Hepático/microbiología , Masculino , Persona de Mediana Edad , Estómago/microbiología , Heridas Penetrantes/microbiologíaRESUMEN
Escherichia vulneris is a gram-negative bacillus that belongs to the family Enterobacteriaceae, with a questioned pathogenic role. However, it has been confirmed as the cause of wound infections. We report the case of a 12-year-old girl, previously healthy, with a diagnosis of septic arthritis of the right knee, secondary to a spinal lesion. Escherichia vulneris, an unusual etiology of septic arthritis in children, was isolated in the joint fluid. This case is one of the first cases of septic arthritis due to E. vulneris, secondary to a plant-derived foreign body in a child, described in the medical literature. The importance of performing the microbiological study of joint fluid in patients with septic arthritis caused by a foreign body of plant-derived origin is emphasized.
Asunto(s)
Artritis Infecciosa/microbiología , Infecciones por Enterobacteriaceae/microbiología , Escherichia/aislamiento & purificación , Articulación de la Rodilla/microbiología , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Biopsia con Aguja , Niño , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Escherichia/patogenicidad , Femenino , Cuerpos Extraños/microbiología , Humanos , Resultado del TratamientoRESUMEN
A concha bullosa forms when the middle turbinate becomes pneumatized, which is a common anatomic variation; however, fungus ball in concha bullosa is rather rare. An otherwise healthy 52-year-old man presented to our ear, nose and throat clinic with the complaints of midfacial pressure headache and malodorous postnasal drip. Computed tomography of the paranasal sinuses demonstrated a polypoid hyperdense lesion with slight microcalcifications in the right nasal cavity, accompanied with a complicated fluid collection in the right frontoethmoideal recess seen as hypodensity in contrast to this hyperdensity. The histopathological examination reported a fungal infection. We present an extremely rare case of isolated fungal mass in the right middle concha detected in an early stage without any evidence of fungal infection of the other paranasal sinuses and discuss the importance of reevaluation of the computed tomography scans in suspicion of a fungal sinusitis.
Asunto(s)
Cuerpos Extraños/diagnóstico , Hongos/aislamiento & purificación , Cefalea/etiología , Micosis/complicaciones , Senos Paranasales/diagnóstico por imagen , Sinusitis/diagnóstico , Diagnóstico Diferencial , Cuerpos Extraños/complicaciones , Cuerpos Extraños/microbiología , Cefalea/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Micosis/diagnóstico , Micosis/microbiología , Senos Paranasales/microbiología , Sinusitis/complicaciones , Sinusitis/microbiología , Tomografía Computarizada por Rayos XRESUMEN
Antibiotic therapy is essential in foreign body associated infections. The treatment regime should aim at high tissue concentrations, high bioavailability, high biofilm penetration and good tolerance. We investigated whether the new cephalosporin ceftobiprole is active against clinical isolates from musculoskeletal foreign body associated infections. One hundred ninety-six staphylococci isolates (coagulase negative staphylococci and Staphylococcus aureus) derived from foreign body associated infections were tested towards susceptibility to ceftobiprole, using a test strip assay and broth microdilution. The MIC for all strains S. aureus indicated susceptibility to ceftobiprole. The MIC of only two strains of coagulase negative staphylococci was above 2 mg/L. Our results show that ceftobiprole might be considered as an off-label treatment option in foreign body associated infections.
Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Cuerpos Extraños/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus/efectos de los fármacos , Humanos , Pruebas de Sensibilidad MicrobianaRESUMEN
OBJECTIVE: Inhaled foreign bodies in children are common and may be complicated by secondary airway tract infection. The inhaled foreign body may act as carrier of infectious material and the aim of this study was to explore the bacterial species associated with aspirated foreign bodies in a cohort of children. METHODS: Retrospective case series of 34 patients who underwent rigid laryngobronchoscopy because of foreign body aspiration. Each patient had a sample taken from tracheobronchial secretions during the procedure. RESULTS: The average patient age was 31.2 months and the average hospital stay was 2.5 days. Of the foreign bodies 24 (71%) were organic in nature and 10 (29%) were non-organic. Twenty eight (82.3%) patients had mixed oropharyngeal flora organisms growth. Fifteen (44%) samples were positive for organisms other than oropharyngeal flora with the most common cultured organisms being: Streptococcus pneumonia (4/12%), Haemophilus influenza (4/12%), Moraxella catarrhalis (4/12%). Four samples (12%) grew a fungus; Candida albicans was cultured in 3 patients and Aspergillus glaucus was identified in one sample. Of the non-oropharyngeal organisms 7(47%) demonstrated antibiotic resistance with four having resistance to amoxycillin, two resistant to penicillin and one resistant to cotrimoxazole. CONCLUSION: Some children who present with aspirated foreign body may be complicated with secondary airway infection. Antibacterial treatment might be considered in some of these cases. The regimen of antibiotics should aim to cover oropharyngeal flora, S. pneumonia, H. influenza and Moraxella catarrhalis.
Asunto(s)
Bronquios , Cuerpos Extraños/microbiología , Aspiración Respiratoria/microbiología , Infecciones del Sistema Respiratorio/microbiología , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Aspergillus/aislamiento & purificación , Aspergillus/fisiología , Broncoscopía , Candida albicans/aislamiento & purificación , Preescolar , Farmacorresistencia Bacteriana , Femenino , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Haemophilus influenzae/aislamiento & purificación , Haemophilus influenzae/fisiología , Humanos , Laringoscopía , Masculino , Microbiota , Moraxella catarrhalis/aislamiento & purificación , Moraxella catarrhalis/fisiología , Orofaringe/microbiología , Aspiración Respiratoria/complicaciones , Aspiración Respiratoria/cirugía , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/etiología , Estudios Retrospectivos , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pneumoniae/fisiologíaRESUMEN
Resumen Escherichia vulneris es un bacilo gramnegativo, perteneciente a la familia Enterobacteriaceae, cuyo rol patógeno ha sido cuestionado. Sin embargo, se ha confirmado principalmente como causante de infecciones de heridas. Presentamos el caso de una niña de 12 años, previamente sana, con diagnóstico de una artritis séptica de rodilla derecha secundaria a una lesión con espina vegetal. En el estudio del líquido articular se aisló E. vulneris, una etiología poco habitual de artritis séptica en niños. Es uno de los primeros casos de artritis séptica por E. vulneris, secundaria a un cuerpo extraño vegetal en un niño, descritos en la literatura médica. Se enfatiza la importancia de realizar el estudio microbiológico del líquido articular en pacientes con artritis séptica originada por un cuerpo extraño de origen vegetal.
Escherichia vulneris is a gram-negative bacillus that belongs to the family Enterobacteriaceae, with a questioned pathogenic role. However, it has been confirmed as the cause of wound infections. We report the case of a 12-year-old girl, previously healthy, with a diagnosis of septic arthritis of the right knee, secondary to a spinal lesion. Escherichia vulneris, an unusual etiology of septic arthritis in children, was isolated in the joint fluid. This case is one of the first cases of septic arthritis due to E. vulneris, secondary to a plant-derived foreign body in a child, described in the medical literature. The importance of performing the microbiological study of joint fluid in patients with septic arthritis caused by a foreign body of plant-derived origin is emphasized.
Asunto(s)
Humanos , Femenino , Niño , Artritis Infecciosa/microbiología , Infecciones por Enterobacteriaceae/microbiología , Escherichia/aislamiento & purificación , Articulación de la Rodilla/microbiología , Biopsia con Aguja , Artritis Infecciosa/tratamiento farmacológico , Resultado del Tratamiento , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Escherichia/patogenicidad , Cuerpos Extraños/microbiología , Antibacterianos/uso terapéuticoRESUMEN
CASE: We present the case of a 17-year-old man who sustained a delayed rupture of a zone-II flexor tendon injury in the long finger from a catfish spine, which caused local envenomization and a likely secondary bacterial infection. He underwent surgical exploration and irrigation and debridement of the finger. The flexor digitorum profundus tendon was found to be lacerated and was primarily repaired. CONCLUSION: Catfish spines can cause traumatic disruption of anatomic structures and can envenomate the area of injury, which can lead to a secondary bacterial infection. We review the literature regarding catfish spine injuries and describe a basic treatment algorithm for patients who are injured by catfish spines.
Asunto(s)
Traumatismos de los Dedos/microbiología , Dedos/diagnóstico por imagen , Cuerpos Extraños/complicaciones , Rotura/complicaciones , Traumatismos de los Tendones/patología , Adolescente , Animales , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Bagres , Traumatismos de los Dedos/tratamiento farmacológico , Traumatismos de los Dedos/cirugía , Dedos/patología , Cuerpos Extraños/microbiología , Humanos , Masculino , Radiografía/métodos , Rango del Movimiento Articular/fisiología , Rotura/cirugía , Traumatismos de los Tendones/tratamiento farmacológico , Traumatismos de los Tendones/cirugía , Resultado del TratamientoRESUMEN
Foreign-body-associated infections are often difficult to treat, given that the associated microorganisms are in a biofilm state. Previously, we showed that a low-amperage direct electrical current (DC) reduces Propionibacterium acnes biofilms formed on implant-associated materials in vitro In this study, low-amperage DC was compared to ceftriaxone treatment or no treatment in a novel rat femur model of foreign-body osteomyelitis. A platinum implant seeded with a P. acnes biofilm (107 CFU/cm2) and 109 CFU of planktonic P. acnes was placed in the femoral medullary cavity. One week later, rats were assigned to one of three treatment groups: no treatment, ceftriaxone treatment, or 200-µA-DC treatment. After 2 weeks of treatment, there were fewer bacteria in the bones of the ceftriaxone group (3.06 log10 CFU/g of bone [P = 0.0209]) and the 200-µA-DC group (0.5 log10 CFU/g [P = 0.0015]) than in those of the control group (6.58 log10 CFU/g). The DC-exposed animals exhibited fewer bacteria than the ceftriaxone-treated animals (P = 0.0330). There were fewer bacteria on the implanted wires in the groups treated with ceftriaxone (0.1 log10 CFU/cm2) or a 200-µA DC (0.1 log10 CFU/cm2) than in the control group (2.53 log10 CFU/cm2 [P, 0.0003 for both comparisons]). Low-amperage DC may be useful for treating, or aiding in the treatment of, foreign-body infections caused by P. acnes.