1/194. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group.BACKGROUND: Since the emergence of methicillin-resistant staphylococcus aureus, the glycopeptide vancomycin has been the only uniformly effective treatment for staphylococcal infections. In 1997, two infections due to S. aureus with reduced susceptibility to vancomycin were identified in the united states. methods: We investigated the two patients with infections due to S. aureus with intermediate resistance to glycopeptides, as defined by a minimal inhibitory concentration of vancomycin of 8 to 16 microg per milliliter. To assess the carriage and transmission of these strains of S. aureus, we cultured samples from the patients and their contacts and evaluated the isolates. RESULTS: The first patient was a 59-year-old man in michigan with diabetes mellitus and chronic renal failure. peritonitis due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus peritonitis associated with dialysis. The removal of the peritoneal catheter plus treatment with rifampin and trimethoprim-sulfamethoxazole eradicated the infection. The second patient was a 66-year-old man with diabetes in new jersey. A bloodstream infection due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus bacteremia. This infection was eradicated with vancomycin, gentamicin, and rifampin. Both patients died. The glycopeptide-intermediate S. aureus isolates differed by two bands on pulsed-field gel electrophoresis. On electron microscopy, the isolates from the infected patients had thicker extracellular matrixes than control methicillin-resistant S. aureus isolates. No carriage was documented among 177 contacts of the two patients. CONCLUSIONS: The emergence of S. aureus with intermediate resistance to glycopeptides emphasizes the importance of the prudent use of antibiotics, the laboratory capacity to identify resistant strains, and the use of infection-control precautions to prevent transmission.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/194. Septic shock due to helicobacter fennelliae in a non-human immunodeficiency virus-infected heterosexual patient.helicobacter fennelliae (formerly campylobacter fennelliae) has been reported to cause bacteremia in homosexual men with or without human immunodeficiency virus (hiv) infection. We report here a 48-year-old, non-hiv-infected, heterosexual man with diabetes mellitus and cirrhosis of the liver who developed bacteremia and septic shock due to H. fennelliae. The patient was treated successfully initially with intravenous ampicillin-sulbactam and ceftazidime, followed by ampicillin-sulbactam only. These agents were active in vitro against the isolate by E-test results. To our knowledge, this is the first documented case of septic shock due to H. fennelliae in a non-hiv-infected, heterosexual, immunocompromised patient.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
3/194. Clinical and radiological findings in patients with gas forming renal abscess treated conservatively.PURPOSE: Emphysematous pyelonephritis in diabetics is considered a potentially lethal infection. mortality rates of patients treated conservatively approaches 80% in some series. These patients often present with signs of sepsis or septic shock. In contrast, gas forming renal abscess is rare, with patients presenting entirely differently from those with emphysematous pyelonephritis. To our knowledge this process has been previously described only in isolated case reports. We describe a series of 5 patients with this distinct process. MATERIALS AND methods: We reviewed the clinical and radiological features of 5 patients with gas forming renal abscesses. RESULTS: Each patient presented with diabetes mellitus with initial blood glucose ranging from 313 to 552 mg./dl., fever (average 101F), flank or abdominal pain and pyuria. No patient had evidence of septic shock at hospitalization. escherichia coli was the documented organism in each case. Mild renal insufficiency was noted in most patients based on serum creatinine. Radiological evaluation revealed gas filled pockets within the renal parenchyma, which were most effectively shown by computerized tomography (CT) of the abdomen. There was no radiological evidence of pus. Percutaneous drainage of an abscess in 1 case did not produce any purulent material or alter the clinical course. Each patient responded to correction of the underlying metabolic abnormalities with intravenous antibiotics (average 23 days) followed by prolonged oral antibiotic therapy (average 9 weeks). In contrast to the management of emphysematous pyelonephritis, surgical or percutaneous drainage was not necessary. Serial CT revealed complete resolution of gas in the parenchyma within 6 months in patients with long-term followup. Of note, gas was persistent on CT months after infection had clinically resolved. CONCLUSIONS: We describe a unique entity within the spectrum of pyelonephritis. The clinical appearance of gas forming abscesses within the renal parenchyma without liquefaction in diabetic patients was remarkably benign compared to the radiographic appearance of the disease process. Conservative management with intravenous and oral antibiotics was successful in each patient, avoiding the need for invasive intervention.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
4/194. An unusual complication of subclavian vein catheterization for total parenteral nutrition.A 25-year-old woman with diabetic ketoacidosis and esophagitis was given total parenteral nutrition to improve her nutritional status. A central venous catheter inserted in the right subclavian vein was well tolerated for three weeks, when infection developed. The line was replaced by a left subclavian line. Within an hour the patient complained of back pain. A chest x-ray film showed that the tip of the catheter was to the left of the mediastinum and that left pleural effusion was present. The line was removed and 1,500 cc of fluid was removed from the left pleural space. The pleural fluid cleared gradually over several days and the patient became asymptomatic.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
5/194. corynebacterium pseudodiphtheriticum pneumonia in an immunocompetent patient.corynebacterium pseudodiphtheriticum is a coryneform and diphtheromorphic bacteria rarely found as a cause of pneumonia in immunocompetent hosts. A case of an immunocompetent patient with C. pseudodiphtheriticum pneumonia is presented. This infection responded well to initial empirical treatment with cefotaxime. Very few cases of pneumonia associated with C. pseudodiphtheriticum have been described in the medical literature, this organism mainly being found in immunocompromised hosts. We report a case of pneumonia in an immunocompetent patient in which C. pseudodiphtheriticum was the only micro-organism isolated.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
6/194. Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus.Using a computer database, we conducted a retrospective review of all ankle fractures treated at our institution from March 1985 to October 1996. Twenty-one patients with diabetes mellitus and isolated ankle fractures that were treated operatively met all inclusion criteria. Seven had insulin-dependent diabetes, and 14 had non-insulin-dependent diabetes. A randomly selected control group of 46 patients without diabetes who also underwent operative treatment of ankle fractures during this same time period were matched for age, sex, and fracture severity. The complication rate was 43% with 13 complications in nine patients with diabetes. There were seven (15.5%) complications in the control group. Complications in the diabetic group included seven infections (five deep, two superficial) and three losses of fixation. The complications were more severe in our diabetic population, requiring seven additional procedures including two below-knee amputations; a third patient refused an amputation. No additional procedures were required in our control group. All complications in our control group resolved with treatment. The relative risk for postoperative complications in patients with diabetes who sustained ankle fractures that were treated operatively was 2.76 times greater than the control group's (95% confidence interval, 1.57-3.97).- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
7/194. Infections of the hand.In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua new guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Some of the more complicated infections such as middle palmar and thenar space infections, suppurative tenosynovitis, osteomyelitis and septic arthritis are of sufficient importance to warrant the attentions of the specialist surgeon when this is possible.- - - - - - - - - - ranking = 0.71428571428571keywords = infection (Clic here for more details about this article) |
8/194. A fatal case of craniofacial necrotizing fasciitis.A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occurred with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. streptococcus and Staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease.- - - - - - - - - - ranking = 0.28571428571429keywords = infection (Clic here for more details about this article) |
9/194. Diabetic bullae: 12 cases of a purportedly rare cutaneous disorder.BACKGROUND: Spontaneous bullae are a characteristic type of skin lesion occurring in patients with diabetes mellitus. These diabetic bullae are considered to be a rare phenomenon; only about 100 cases have been described in the literature since the disorder was first reported 70 years ago. methods: We collected a series of patients with diabetic bullae who were referred to us at a veterans Affairs Medical Center Clinic specializing in diabetic foot problems. We then reviewed the medical literature for similar cases and summarized the available information. RESULTS: We saw 12 patients with typical diabetic bullae over an 8-year period in our clinic. The clinical presentation and outcome of the lesions in these patients were similar to those in previously reported cases. The patients were mostly elderly, all but one had lesions located on the lower extremities, all had peripheral neuropathy, two had secondary staphylococcal infection of their bullae, and in all patients the lesions healed without scarring. Although most of the patients had had previous similar lesions, the diagnosis of diabetic bullae had not been previously reported in any of them. CONCLUSIONS: We have reviewed the clinical syndrome of diabetic bullae and presented brief clinical details of these cases; we offer several vignettes and photographs of these lesions to remind clinicians of what we believe is a not so rare cutaneous disorder.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
10/194. The clinical application of a fetal membrane on a diabetic patient's injury.A description of the successful use of a fetal membrane in the recovery of a injured patient is presented. A diabetic female patient, 63 years old, was accidentally injured with a winnowing fork, which opened the skin of the front side of her left foot. For first two weeks, she was submitted to a treatment involving antibiotics, analgesics and antiinflammatories, but the infection did not disappear and the pain was almost unbearable. At the end of the third week, the injury underwent surgical washing with epidural blockage; suitable insulin dose and oral antidiabetics controlled the high-glucose concentration. However, due to the intensity of the pain, a risky epidural blockage was administered every four hours for 12 days. Finally, a radiosterilised human fetal membrane, which was collected at HCSAE and processed at ININ, was used as a biological wound dressing. Biological control of the tissue was performed at Facultad de Quimica de la Universidad Nacional Autonoma de mexico (The chemistry faculty of the National Autonomous University of mexico) (UNAM). As a result, the pain first diminished and then stopped. The healing process started in a few days and led to a complete recovery in 2 1/2 months. At present, the patient is in good condition, living a normal life.- - - - - - - - - - ranking = 0.14285714285714keywords = infection (Clic here for more details about this article) |
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