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2.
Ann Otol Rhinol Laryngol ; 129(4): 376-379, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31762293

RESUMO

OBJECTIVES: Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics. METHODS: Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS. RESULTS: Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively (P = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, P-value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10). CONCLUSION: Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.


Assuntos
Abscesso , Dexametasona/administração & dosagem , Drenagem , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pescoço , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes/isolamento & purificação , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Administração Intravenosa , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Criança , Pré-Escolar , Drenagem/métodos , Drenagem/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Esvaziamento Cervical/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/cirurgia , Estados Unidos
3.
Infection ; 48(1): 3-5, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31079347

RESUMO

PURPOSE: Even though prosthetic valve endocarditis due to coagulase-negative staphylococci (CoNS) is widely documented and attracts global attention, native valve endocarditis due to CoNS has been also described lately and may warrant closer attention due to the relative increased incidence. METHODS: We describe a 35-year-old male patient who is a former resident of a long-term health-care facility with multiple co-morbidities, diagnosed with native aortic valve S. capitis endocarditis and underwent conservative antimicrobial treatment with full recovery and no recurrence after 6 months' follow-up. In addition, we reviewed the English literature on all reported cases of S. capitis endocarditis. RESULTS: Infective endocarditis due to S. capitis has thus far been described in 13 patients. All but three had involved native valves with two infected prosthetic valves and a single case of infection in an implanted transvenous pacemaker. Although the number of cases of endocarditis due to S. capitis is small, early removal of either a prosthetic valve or infected pacemaker would appear prudent, while native valve endocarditis could successfully be treated with appropriate antimicrobials alone. CONCLUSIONS: Staphylococcus capitis is classified as coagulase-negative staphylococci with the inherent ability to cause debilitating native valve endocarditis and is usually managed conservatively.


Assuntos
Endocardite Bacteriana/terapia , Infecções Estafilocócicas/terapia , Staphylococcus capitis/fisiologia , Adulto , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia
4.
BMJ Case Rep ; 12(12)2019 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-31818900

RESUMO

A 50-year-old Indigenous woman, on home haemodialysis, was found to have a large mycotic aneurysm of the proximal left anterior descending coronary artery at the site of a previous drug-eluting stent. Blood cultures grew methicillin-sensitive S taphylococcus aureus bacteraemia. She underwent a complex operation involving resection of the mycotic aneurysm, removal of the stent and a coronary artery bypass graft to the distal left anterior descending (LAD) coronary artery using the left internal mammary artery. She had a complicated intensive care unit admission with pericardial tamponade on day 1 postoperatively requiring reopening and removal of clot and type 1 respiratory failure requiring reintubation on day 10 postoperatively. Once extubated, she developed prolonged hyperactive delirium and a significant decline in mobility. Over the course of a 6-week hospital admission, she received extensive multidisciplinary care and was discharged for rehabilitation to a peripheral hospital. She was discharged home after rehabilitation with ongoing follow-up with infectious diseases.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Coronário/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estafilocócicas/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/tratamento farmacológico , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/tratamento farmacológico , Angiografia Coronária , Remoção de Dispositivo , Stents Farmacológicos , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Resultado do Tratamento
5.
Infect Dis Obstet Gynecol ; 2019: 4149587, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31871398

RESUMO

Tubo-ovarian abscess may develop in women with endometrioma following assisted reproductive technology (ART). The infection, though rare, is typically late in onset and may present several months after the procedure, and in pregnancy-with the risks of abortion and premature labor. It is thought that transcutaneous oocyte retrieval during ART is the route for bacterial contamination resulting in infection of the endometrioma. Pathogens reported in the literature include Escherichia coli (E. coli) and Group B streptococcus (GBS) but Staphylococcus lugdunensis (S. lugdunensis), a coagulase-negative staphylococcus (CoNS), and groin and perineal skin commensal was isolated from the endometrioma in this case. We discuss the challenges in diagnosis and treatment of this rare condition and the implications of the discovery that an organism previously dismissed as a contaminant has emerged as a causative organism in severe, deep-seated infections of soft tissues in recent literature.


Assuntos
Coagulase/metabolismo , Endometriose/microbiologia , Cistos Ovarianos/microbiologia , Técnicas de Reprodução Assistida/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Staphylococcus lugdunensis/metabolismo , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefalexina/administração & dosagem , Cefalexina/uso terapêutico , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Endometriose/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Recuperação de Oócitos/efeitos adversos , Cistos Ovarianos/cirurgia , Gravidez , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Staphylococcus lugdunensis/isolamento & purificação , Resultado do Tratamento
6.
Can J Cardiol ; 35(11): 1475-1482, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679619

RESUMO

BACKGROUND: Little is known about the mid-term prognosis of nonelderly patients (≤60 years) after the surgical treatment of isolated aortic valve infective endocarditis (IE). Better characterization of these outcomes could help in tailoring the surgical management in these patients. METHODS: From 2000 to 2015, 164 adult patients ≤60 years of age (mean 46 ± 11 years, 81% male) underwent surgical treatment for isolated aortic valve IE in 2 high-volume Canadian centers. Twenty-three patients (14%) were intravenous drug users (IVDUs). Patients with recurrent IE or concomitant endocarditis on other valves were excluded. The aortic valve was replaced with a mechanical prosthesis (44%), a tissue valve (30%), a homograft (18%), or a Ross procedure (9%). Mean follow-up was 6.2 ± 4.6 years (92% complete). RESULTS: Thirty-day mortality was 7%. Actuarial survival rates at 5 and 10 years were 80 ± 3% and 71 ± 4%, respectively. IVDU (hazard ratio [HR] 3.8, 95% CI 1.4-10.1; P = 0.01) and prosthetic valve endocarditis (HR 2.6, 95% CI 1.1-6.4; P = 0.04) were associated with increased mid-term mortality. Mid-term survival was best in non-IVDU patients with native valve endocarditis, yet lower than a matched elective aortic valve replacement (AVR) population. Overall, freedom from recurrence of IE at 1, 5, and 10 years was 94 ± 2%, 91 ± 3%, and 89 ± 3%, respectively. IVDU was associated with higher rates of recurrence, especially in the first year after surgery. CONCLUSIONS: In nonelderly adults undergoing surgery for aortic valve IE, mid-term survival is suboptimal. Although non-IVDU patients with native valve endocarditis have better mid-term outcomes, survival remains lower than a matched population of elective AVR in nonelderly patients.


Assuntos
Valva Aórtica/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Infecções Estafilocócicas/cirurgia , Adolescente , Adulto , Canadá/epidemiologia , Endocardite Bacteriana/mortalidade , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem
7.
J Surg Orthop Adv ; 28(3): 224-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675300

RESUMO

The purpose of this study was to compare patient factors and outcomes in conservatively and surgically treated patients with spinal epidural abscess (SEA). This was a single-center retrospective review of adult patients treated for SEA of the lumbar spine. Primary treatment outcome was readmission for recurrent abscess. Sixty-one patients met inclusion criteria: 59% male, mean age 56.9 years, and body mass index 30.8 kg/m2. Initially 47.5% of patients were treated with conservative measures and 52.5% were treated with surgery. In the conservative group, 31.0% failed treatment and underwent delayed surgery; 26.2% of the overall cohort was readmitted for SEA. Readmitted patients had a greater incidence of history of methicillin-resistant Staphylococcus aureus (p = .048), recurrent infections (p = .008), and recent sepsis and bacteremia (p = .005). Nearly one-third of patients failed initial conservative treatment and needed delayed surgery; however, no significant differences were found between the two treatment groups. Patients with a past history of infections may require more aggressive treatment and closer follow-up, because they are at higher risk for recurrence and readmission. (Journal of Surgical Orthopaedic Advances 28(3):224-231, 2019).


Assuntos
Abscesso Epidural , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Adulto , Abscesso Epidural/diagnóstico , Abscesso Epidural/cirurgia , Feminino , Humanos , Vértebras Lombares , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento
8.
Orthop Surg ; 11(6): 1109-1119, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31701667

RESUMO

OBJECTIVE: Surgery is indicated when antibiotic treatment fails in pyogenic spondylodiscitis, which is caused by pathogens such as the Staphylococcus species. The aim of the present study was to investigate the efficacy and safety of the oblique lateral interbody fusion (OLIF) corridor approach combined with posterior pedicle screw fixation for treating pyogenic spondylodiscitis. METHODS: This was a retrospective case series study. A total of 11 patients with an average age of 60.7 years (range, 40-70 years; 10 males and 1 females) with lumbar pyogenic spondylodiscitis who underwent single-stage debridement and reconstruction using the OLIF corridor combined with posterior pedicle screw fixation were recruited in our study from June 2016 to July 2017. All patients had single-level pyogenic spondylodiscitis between T12 and L5 . The baseline data, perioperative outcomes (operative time, intra-operative blood loss, and intra-operative complication), postoperative laboratory tests (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], white blood count [WBC], and tissue culture results), long-term complications (recurrence, fixation failure, and bony non-fusion rates), and duration of antibiotic administration were reviewed. Outcomes evaluated using a variety of scales including visual analog scale (VAS) score and Oswestry disability index (ODI), were compared pre-operatively and post-operatively. RESULTS: The mean follow-up period of time was 18.3 months. The average operative time and intra-operative blood loss were 217.0 ± 91.91 min and 220.9 ± 166.10 mL, respectively. There were no intra-operative complications, except in 1 patient who encountered somatosensory evoked potentials changes and 1 patient who had motor evoked potentials changes, both without post-surgery neurological deficits. Causative organisms were identified in 4 patients: Staphylococcus aureus in 1 patient and Streptococcus in 3 patients. At approximately 8.8 weeks after surgery, WBC, CRP, and ESR had returned to normal levels. All patients were pain free with no recurring infection. There was no fixation failure during follow up. Solid bony fusions were observed in all cases within 6 months. At the final follow up, the mean VAS (0.6 ± 0.69) and ODI (14.4 ± 4.27) were significantly lower than those before surgery (P < 0.05). CONCLUSION: One-stage debridement with autogenous iliac bone graft through the OLIF corridor combined with posterior pedicle screw fixation is effective and safe for single-level spontaneous lumbar pyogenic spondylodiscitis after antibiotic treatment fails.


Assuntos
Transplante Ósseo/métodos , Desbridamento/métodos , Discite/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Avaliação da Deficiência , Discite/microbiologia , Feminino , Humanos , Ílio/transplante , Vértebras Lombares/microbiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Parafusos Pediculares , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia
9.
Turk J Pediatr ; 61(1): 40-43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559720

RESUMO

Zhu Y, Xu F. The pathogens and curative effects analysis of perianal abscess of infants under 3 months. Turk J Pediatr 2019; 61: 40-43. In order to guide clinical treatment for perianal abscess of young infants, the characteristics of pathogens and curative effects analysis were conducted. Bacterial culture results, antibiotics susceptibility tests and curative effects of abscess incision were retrospectively analyzed in 66 cases of perianal abscess of infants under 3 months. There were 48 cases of Klebsiella pneumoniae, 7 cases of Staphylococcus, 6 cases of Escherichia coli, 5 cases of Proteus in the pathogen culture results. Klebsiella pneumoniae, the predominant pathogen, was susceptible to most antibiotics, especially to imipenem, cefoperazonesulbactam and amikacin with low drug resistance rates. However, high drug resistance rates were found to ampicillin and nitrofurantion. After abscess incision, the complication rate of anal fistula was 6.6% in infants under 3 months and 60.3% in the adult group. There was significant difference P<0.01. In conclusion, Klebsiella pneumoniae was the most common pathogen in perianal abscess of infants under 3 months and was commonly resistant to ampicillin and nitrofurantion. Since perianal abscess of infants under 3 months is a self-limited disorder, simple surgical intervention and synchronous sensitive antibiotic administration are suggested as the optimal management.


Assuntos
Abscesso , Doenças do Ânus , Infecções por Escherichia coli , Infecções por Klebsiella , Klebsiella pneumoniae/isolamento & purificação , Infecções Estafilocócicas , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Doenças do Ânus/diagnóstico , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/microbiologia , Doenças do Ânus/cirurgia , Terapia Combinada , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/cirurgia , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento
10.
Can J Cardiol ; 35(10): 1416-1418, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31495682

RESUMO

In this article we review the perspectives in the literature around surgical treatment for infective endocarditis (IE) in people who use intravenous drugs (PUID). PUID are at increased risk for IE; however, controversy exists regarding how to best manage these patients. We explore the outcomes for surgical treatment in PUID with IE, contrasting these with patients with IE who do not use drugs. We describe some of the perspectives in the literature around second valve replacement for PUID with IE, arguing that moralistic arguments are not on the basis of evidence and perpetuate the stigma experienced by PUID who seek treatment for IE. Finally, we explore the role of substance use interventions in the treatment of PUID with IE, and advocate for further evidence. PUID with IE are a highly stigmatized patient subgroup for whom best practice management strategies are not always implemented, emphasizing the need for further research and advocacy.


Assuntos
Endocardite/cirurgia , Adulto , Endocardite/etiologia , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus , Abuso de Substâncias por Via Intravenosa/complicações , Resultado do Tratamento
11.
Indian J Med Microbiol ; 37(1): 67-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424013

RESUMO

Background: Prosthetic joint infection (PJI) is one of the most challenging cases that confront modern orthopaedics. Two-stage revision, which is the standard of care for PJI, is the preferred mode of treatment for these infections. Aims and Objectives: To study the microbiological profile of prosthetic joint infections (PJI) in the hip and to assess the efficacy of a two stage revision surgery for PJI. We also aimed to study the sensitivity and specificity of ESR and CRP in the diagnosis of PJI. Materials and Methods: The microbiological profile, clinical and radiological outcomes of 22 patients who had a two-stage revision for PJI of the hip between 2013 and 2017 were retrospectively analysed. PJI was defined using the criteria provided by the International Consensus Statement on PJI 2013. Results: Staphylococcus aureus was found to be the most common organism in PJI. Debridement was successful in removing the organism in 74% of PJI. At the time of re-implantation (second stage), six joints grew organisms that were different from that isolated at the index debridement - coagulase-negative staphylococci (3cases) and enterococci (3cases). Other infection parameters for these patients were negative. None of the patients who had two-stage revision surgery had clinical evidence of reinfection or radiological evidence of loosening at a mean of 2-year follow-up. An ESR cut off of >30mm/hr had a sensitivity of 75% and specificity of 88% in predicting PJI. A CRP >10mg/L had a sensitivity of 75% and specificity of 69%. The sensitivity and specificity of using both ESR and CRP cut-offs in the diagnosis of infection were 57% and 94%, respectively. The positive predictive value was 94% and negative predictive value was 56%. Conclusion: The outcomes of the study justify a two-stage revision arthroplasty for PJI of the hip. The use of ESR and CRP as screening tests for the success of debridement has value - but should be interpreted with caution.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Sedimentação Sanguínea , Proteína C-Reativa/análise , Desbridamento , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação , Adulto Jovem
12.
Ann Vasc Surg ; 61: 471.e3-471.e7, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394215

RESUMO

The present case describes acute and early infection of a superficial femoral artery drug-eluting stent (DES) in a 65-year-old patient 2 days after its implantation in outpatient clinic, with intense clinical presentation. The initial indication was Rutherford 3 peripheral artery disease. Radical treatment by means of stent explantation and femoro-femoral bypass using autogenous vein was performed. Both stent and blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Informative imaging and intraoperative view are provided. Local evolution was satisfactory but endocarditis occurred secondarily. The pathophysiology of this first reported DES infection and the management of the infected vessel are discussed, in light of data derived from coronary literature and open vascular surgery.


Assuntos
Stents Farmacológicos/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/microbiologia , Doença Arterial Periférica/terapia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Idoso , Antibacterianos/uso terapêutico , Remoção de Dispositivo , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Artéria Femoral/cirurgia , Humanos , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Veia Safena/transplante , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Fatores de Tempo , Resultado do Tratamento
13.
Infect Dis (Lond) ; 51(9): 694-700, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31355687

RESUMO

Background: Aggressive surgery such as en bloc joint resection is favored for treating uncommon sternoclavicular (SC) septic arthritis, based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with Staphylococcus aureus SC septic arthritis treated medically or with limited surgery. Methods: All adult patients with this septic arthritis at the Asan Medical Center between September 2009 and December 2016 were reviewed. Limited surgery was defined as simple incision, drainage, and debridement of the infected joint. Results: Of 22 patients enrolled, 11 received medical treatment only, and 11 underwent limited surgery, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes and liver cirrhosis, and none had intravenous drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscesses tended more often to undergo limited surgery than patients without such abscesses (73% vs. 27%, p = .09). The median duration of intravenous antibiotics was 35 days (IQR, 25-46 days). Treatment was successful in all cases. In a median 53-week follow-up (IQR, 8-171 weeks), there was no relapse of arthritis or joint deterioration. Conclusions: Medical treatment alone or with limited surgery could be successful therapeutic strategies for complicated S. aureus SC septic arthritis in selected patients.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Articulação Esternoclavicular/microbiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Resultado do Tratamento
14.
J Card Surg ; 34(9): 877-879, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31269268

RESUMO

A 57-year old male with a dual-chamber pacemaker and 40-year history of hemodialysis and autoinflammatory disease developed a large, 35 × 35 mm intracardiac vegetation on the right ventricular pacing lead. As this mass was large enough to occlude the tricuspid valve orifice, transvenous lead extraction was deemed unsuitable. Instead, an urgent surgical extraction of the whole pacemaker system, including leads and vegetation, was conducted under cardiopulmonary bypass. In light of a high risk of recurrent blood infection, a new dual-chamber pacing system was then immediately re-established using epicardial pacing leads on the right atrium and ventricle instead of transvenous electrodes. This case of a rare, giant intracardiac lead vegetation lacked most known causal factors, except for renal failure, but a possibly immunosuppressed cardiac microenvironment due to long-term steroid therapy may have been an important influencing factor.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/métodos , Ponte Cardiopulmonar/métodos , Remoção de Dispositivo/métodos , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Infecções Estafilocócicas/cirurgia , Ecocardiografia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/microbiologia , Pericárdio , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Reimplante/métodos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificação
15.
Ann R Coll Surg Engl ; 101(7): e154-e156, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155912

RESUMO

Infected pseudoaneurysms are a vascular emergency, necessitating urgent surgical management. Owing to the infected field, a synthetic graft may be inappropriate in patients for whom autografting is impossible. Ligation of the artery is the usual management, often leading to amputation. We report a case of cadaveric allografting of the common femoral artery in a patient with a traumatic, infected pseudoaneurysm, who was taking immunosuppressive therapy for a liver transplant. The patient was followed up with ultrasound at 12 months and was found to have a significant graft stenosis, which was treated successfully with angioplasty. At 18 months, the patient remained well. This case describes the successful implantation of a cadaveric allograft into a patient with an infected pseudoaneurysm, negating the for need primary ligation.


Assuntos
Falso Aneurisma/cirurgia , Veia Femoral/transplante , Flebotomia/efeitos adversos , Infecções Estafilocócicas/cirurgia , Enxerto Vascular/métodos , Adulto , Aloenxertos/transplante , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/microbiologia , Cadáver , Angiografia por Tomografia Computadorizada , Artéria Femoral/cirurgia , Veia Femoral/diagnóstico por imagem , Veia Femoral/lesões , Veia Femoral/microbiologia , Virilha , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
16.
Rev Cardiovasc Med ; 20(1): 35-39, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-31184094

RESUMO

Coronary artery septic embolization is a rare, but severe complication of infective endocarditis involving the leftside of the valves. The first case mentioned in the literature was a postmortem finding of a left anterior descending coronary artery occlusion by a vegetation fragment. Since this case, there have been several therapeutic strategies published with this clinical setting including medical treatment, percutaneous coronary angioplasty addressing coronary occlusion, surgical intervention for both the infected valve and coronary embolization, and hybrid procedures with transcatheter septic embolus aspiration followed by surgical valvular interventions. Out of the three interventions mentioned, the latter provided the best results and was in concordance with results observed in a case of mitral valve infected endocarditis complicated with acute occlusion of the left anterior descending coronary artery in patient whose comorbidities included hypertrophic obstructive cardiomyopathy. A transcatheter left anterior descending coronary artery embolus aspiration was performed , followed by a surgical mitral valve replacement and septal myectomy with an uneventful postoperative course. Although rare, this severe complication of infective endocarditis has a specific clinical course and therapeutic strategy, and in our opinion, it could be mentioned as a separate entity among embolic complications of infective endocarditis in future guidelines. Previously published cases suggest that the hybrid intervention might be the therapy of choice for this clinical setting; however, larger studies are necessary for confirmation.


Assuntos
Oclusão Coronária/microbiologia , Embolia/microbiologia , Endocardite Bacteriana/microbiologia , Valva Mitral/microbiologia , Infecções Estafilocócicas/microbiologia , Antibacterianos/uso terapêutico , Cateterismo Cardíaco , Oclusão Coronária/diagnóstico , Oclusão Coronária/terapia , Embolia/diagnóstico , Embolia/terapia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Sucção , Resultado do Tratamento
18.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975780

RESUMO

A 40-year-old woman presented with postoperative fever. Echocardiography revealed a large pedunculated cauliflower right atrial mass of heterogeneous echogenicity attached to the eustachian valve measuring about 2×3 cm. She underwent surgical excision, gross and microscopical examination were consistent with eustachian valve infective endocarditis.


Assuntos
Endocardite Bacteriana/diagnóstico , Valvas Cardíacas , Histerectomia/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto , Diagnóstico Diferencial , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Feminino , Febre/etiologia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/cirurgia
19.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898961

RESUMO

Osteomyelitis is an inflammatory process of the bone caused by an infection. The key to successful management is early recognition and treatment, as complications can arise if interventions are not done in a timely manner. Subacute or chronic osteomyelitis is associated with avascular necrosis of bone requiring surgical debridement and antibiotic therapy. Here, we describe a case illustrating an uncharacteristic presentation of knee pain ending with multiple surgical debridements in a healthy male.


Assuntos
Abscesso/diagnóstico por imagem , Osteomielite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Abscesso/cirurgia , Desbridamento , Diagnóstico Diferencial , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Osteomielite/microbiologia , Osteomielite/cirurgia , Dor/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Ultrassonografia Doppler
20.
J Bronchology Interv Pulmonol ; 26(2): 132-136, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30908392

RESUMO

Chronic pleural infection is characterized by thickened pleura and nonexpandable lung often requiring definitive surgical intervention, such as decortication and/or pleural obliteration procedures. Such procedures are associated with significant morbidity and require proper patient selection for a successful outcome. We report a cohort of 11 patients with pleural space infection and a nonexpandable lung treated with tunneled pleural catheters (TPCs). Following placement, hospital discharge and TPC removal occurred after a median of 5 and 36 days, respectively. Three patients presented with residual loculated effusion that resolved with instillation of intrapleural fibrinolytic therapy. One patient eventually required open window thoracostomy for ongoing pleural infection due to poor medical compliance with TPC care and drainage instructions. TPCs represent an alternative option for drainage of an infected pleural space in nonsurgical candidates with a nonexpandable lung. Their use, as a compliment to traditional treatment, may facilitate prompt hospital discharge and ambulatory management in patients with limited life expectancy.


Assuntos
Cateteres , Infecções/cirurgia , Pleurisia/cirurgia , Toracostomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/cirurgia , Tubos Torácicos , Drenagem , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/cirurgia , Feminino , Fluoroscopia , Infecções por Fusobacterium/tratamento farmacológico , Infecções por Fusobacterium/cirurgia , Humanos , Infecções/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pleurisia/tratamento farmacológico , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/cirurgia , Cirurgia Torácica Vídeoassistida , Toracoscopia
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