Beta-hemolytic group a streptococcal orthopaedic infections: Our institutional experience and review of the literature.

Group A streptococcal (GAS) infections have high morbidity and mortality due to toxin production and tissue invasion. We reviewed all orthopaedic GAS infections at our medical centre between January 2017 and April 2019. Median age was 56 years. At least 60% had a body mass index (BMI) of ≥30 kg/m2. Median Charlson comorbidity score was 3 (range 0-7). Clinical cure at 90 days was achieved in only 62%. All 4 patients with underlying orthopaedic hardware were cured. Toxin-neutralizing antibiotics and intravenous immunoglobulin were underutilized. Our review confirms poor outcomes from GAS orthopaedic infections without optimal management.

Fatal influenza myocarditis with incessant ventricular tachycardia.

Influenza myocarditis is an underappreciated and severe complication of influenza infection, estimated to be present in about 10% of all influenza cases. We present a case of a woman who precipitously died of fulminant influenza myocarditis and then review the historical data, literature and expert recommendations for suspecting and managing influenza myocarditis.

Corynebacterium kroppenstedtii: a challenging culprit in breast abscesses and granulomatous mastitis.

PURPOSE OF REVIEW: Corynebacterium kroppenstedtii is a difficult pathogen associated with granulomatous mastitis and recurrent breast abscesses. Despite over a dozen studies, there is no guidance on surgical interventions, steroid use, or dosing or duration of antibiotic treatment. RECENT FINDINGS: Initially seen in predominantly Maori and Pacific Islander multiparous, postlactating women, C. kroppenstedtii breast infection has since been reported throughout the world, including in nulliparous women. Additionally, emerging data suggest that hyperprolactinemia is a modifiable risk factor for these infections. This article reviews a patient case and data from 87 other cases to compile current best practices for diagnosis, treatment, and monitoring, and provides areas for future study. SUMMARY: In cases of granulomatous mastitis and breast abscess, especially if recurrent, infection with C. kroppenstedtii should be considered. Microbiologists should be alerted to the specialized growth conditions and tools needed for appropriate culturing, identification, and antibiotic susceptibility testing. Clinicians should utilize a multimodal approach with surgical and antibiotic treatment to maximize clinical cure and reduce recurrence.

Ceftolozane-Tazobactam for the Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infections: A Multicenter Study.

BACKGROUND: Multidrug-resistant Pseudomonas aeruginosa infections remain common in hospitals worldwide. We investigated the outcomes associated with the use of ceftolozane-tazobactam for the treatment of these infections. METHODS: Data were collected retrospectively from 20 hospitals across the United States about adults who received ceftolozane-tazobactam for the treatment of multidrug-resistant P aeruginosa infections of any source for at least 24 hours. The primary outcome was a composite of 30-day and inpatient mortality, and secondary outcomes were clinical success and microbiological cure. Multivariable regression analysis was conducted to determine factors associated with outcomes. RESULTS: Two-hundred five patients were included in the study. Severe illness and high degrees of comorbidity were common, with median Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 19 (interquartile range [IQR], 11-24) and median Charlson Comorbidity Indexes of 4 (IQR, 3-6). Delayed initiation of ceftolozane-tazobactam was common with therapy started a median of 9 days after culture collection. Fifty-nine percent of patients had pneumonia. On susceptibility testing, 125 of 139 (89.9%) isolates were susceptible to ceftolozane-tazobactam. Mortality occurred in 39 patients (19%); clinical success and microbiological cure were 151 (73.7%) and 145 (70.7%), respectively. On multivariable regression analysis, starting ceftolozane-tazobactam within 4 days of culture collection was associated with survival (adjusted odds ratio [OR], 5.55; 95% confidence interval [CI], 2.14-14.40), clinical success (adjusted OR, 2.93; 95% CI, 1.40-6.10), and microbiological cure (adjusted OR, 2.59; 95% CI, 1.24-5.38). CONCLUSIONS: Ceftolozane-tazobactam appeared to be effective in the treatment of multidrug-resistant P aeruginosa infections, particularly when initiated early after the onset of infection.

Treatment of a complex orthopaedic infection due to extensively drug-resistant Pseudomonas aeruginosa.

According to the Centers for Disease Control and Prevention (CDC), approximately 51 000 healthcare-associated infections caused by Pseudomonas aeruginosa occur annually in the USA, more than 6000 of which (13%) are caused by multidrug resistant (MDR) strains. Ceftolozane/tazobactam (TOL/TAZ) (Zerbaxa) was approved by the US Food and Drug Administration (FDA) in December 2014 for the treatment of complicated intra-abdominal and urinary tract infections. At this time, clinical data on the role of TOL/TAZ treatment outside of FDA-approved indications is limited. Herein, we present a case of extensively drug-resistant (XDR) P. aeruginosa osteomyelitis of the upper extremity, which was successfully treated with TOL/TAZ for 8 weeks with optimal clinical and laboratory responses. Monotherapy with TOL/TAZ appears effective for treatment of complicated bone and joint infections with XDR P. aeruginosa in combination with comprehensive surgical management, particularly when few antibiotic options exist.

Periprosthetic hip joint infection with Aspergillus terreus: A clinical case and a review of the literature.

Fungal periprosthetic joint infections due to Aspergillus species are rare but are associated with significant cost and morbidity. We present a case of Asperigillus terreus prosthetic joint infection of the hip. The patient was successfully treated with a prolonged course of systemic antifungals along with surgical management.