1/11. klebsiella pneumoniae psoas abscess: predominance in diabetic patients and grave prognosis in gas-forming cases.Seven cases of psoas abscess caused by klebsiella pneumoniae were observed at the National Cheng Kung University Hospital within a period of 4.5 years. These cases constituted 25% of a total 28 episodes of non-tuberculous psoas abscess, ranking second to those caused by staphylococcus aureus (8 cases). Eight cases of psoas abscess caused by K. pneumoniae were identified from medline, and 5 of which were reported from taiwan. Of these 8 cases, 1 neonatal case was excluded, and the remaining 7 adult cases were combined with the 7 cases in this series for analysis. The mean age was 53.8 years, and diabetes mellitus was the most common underlying disease. fever and pain on the flank and back area were the common findings. The interval between the onset of symptoms and diagnosis ranged from 1 to 60 days. The most common sites of concurrent infection were the urinary tract (6 cases; 43%) and bone (3 cases; 21%). All patients received percutaneous or surgical drainage in addition to antibiotic treatment. Gas formation was present in 5 of the 12 patients recorded, and 4 of them died during hospitalization. Only 1 patient had a metastatic infection with osteomyelitis of the left radius and right humerus; he had experienced 5 episodes of recurrent K. pneumoniae infections in different sites. We concluded that K. pneumoniae should be considered as an important endemic pathogen of psoas abscess in diabetics in taiwan. The high mortality rate in the gas-forming cases should also be highlighted. Early recognition, empiric antimicrobial coverage for K. pneumoniae, and aggressive drainage or debridement are indicated in these patients.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
2/11. Successful medical management of multifocal psoas abscess following cesarean section: report of a case and review of the literature.The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
3/11. klebsiella pneumoniae septic arthritis of a lumbar facet joint.Only 3 cases of isolated septic arthritis of a lumbar facet joint have been reported, all due to staphylococcus aureus. We describe a case of klebsiella pneumoniae septic arthritis of a lumbar facet joint in an HLA-B27 positive patient.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
4/11. Case report: spinal epidural abscess from klebsiella pneumoniae.We report a rare case of cervical spinal epidural abscess due to klebsiella pneumoniae. While the most likely pathogen is staphylococcus aureus, 2.5% of CNS infections have been attributed to klebsiella pneumoniae. The source of infection in this case is suspected to be from cervical vertebra osteomyelitis/discitis that expanded to epidural space. Prompt drainage of the abscess by decompression with debridement is the key of management that is shown to decrease morbidity and mortality in epidural abscess patients.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
5/11. Pubic osteomyelitis due to klebsiella pneumoniae in a patient with diabetes mellitus.osteomyelitis of the pubic symphysis or pubic osteomyelitis is a rare entity that is encountered in certain groups of people such as athletes, intravenous drug users, patients with pelvic malignancy, and patients who have undergone surgical manipulations of the genitourinary system. The most frequent causative organism is staphylococcus aureus. K pneumoniae is a common pathogen in diabetic patients, but pubic osteomyelitis due to K pneumoniae has not previously been described. We present a diabetic patient with pubic osteomyelitis caused by K pneumoniae without known predisposing factors.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
6/11. Bacterial esophagitis in immunocompromised patients.We studied the clinical and pathologic features of bacterial esophagitis in three index cases identified by endoscopic biopsy and in 20 autopsy cases. Fourteen of the 23 patients had malignant hematologic conditions, aplastic anemia, or solid tumors; ten were profoundly neutropenic (white blood cell count, less than 100/mm3 [less than 0.1 X 10(9)/L]). The organisms involved in bacterial esophagitis were gram-positive cocci in 14, gram-negative bacilli in three, mixed gram-negative bacilli and gram-positive cocci in five, and gram-positive bacilli in one. Four patients had bacteremic bacterial esophagitis; all were immunocompromised, three by profound neutropenia and one by gestational prematurity. bacteria causing bacteremic bacterial esophagitis were all gram-positive: viridans-group streptococci. staphylococcus aureus, Staphylococcus epidermis, and bacillus species. Our study suggests that bacterial esophagitis is more common than has been recognized in the past and should be considered as a potential source of bacteremia in immunocompromised patients.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
7/11. A survey of infections in stereotactic surgery.In 365 consecutive intracranial stereotactic procedures over a 6-year period, there were three postoperative infections; 1 case of increased neurological deficit and 1 of fatality. staphylococcus aureus was the most common organism involved; however, multiple organisms were seen in 2 cases. Multiplicity of organisms necessitated the use of a broad spectrum of antibiotics in the preoperative and postoperative periods. The method described has permitted an infection rate which compares favorably to other reports in the literature. Perioperative antibiotics, antibiotic-containing irrigation solutions, and careful attention to sterile techniques seem to be instrumental in maintaining a low infection rate in our study. Since the new spheroid design has been used, there have been no infections.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
8/11. Acute klebsiella epiglottitis: considerations for initial antibiotic coverage.Acute epiglottis due to klebsiella pneumoniae in an adult patient is described. The patient failed to respond to ampicillin and required cephalosporin therapy as well as surgical drainage. In view of increased resistance of Hemophilus influenzae to ampicillin and because of other possible etiologic agents such as staphylococcus aureus and non-Hemophilus gram-negative rods, consideration should be given for the initial use of one of the recently introduced cephalosporins such as moxalactam or cefamandole in the treatment of adult epiglottitis.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
9/11. Pathological study of infective endocarditis on Hancock porcine bioprostheses.A pathological study has been performed on 10 infected Hancock bioprostheses removed from nine patients who died of prosthetic endocarditis. The devices had been in place from 2 to 87 months (average 37.5), the interval between operation and onset of infection averaging 30 months. The offending organisms were Gram negative bacteria in three patients (klebsiella pneumoniae, enterobacter cloacae, and serratia marcescens), Gram positive bacteria in two (staphylococcus aureus and streptococcus viridans), and fungi in four (candida species in three and aspergillus species in one). Gross examination of the explants revealed in most cases a vegetative endocarditis of one porcine valve leaflets. Septic embolization occurred in five cases owing to the high friability of the vegetations. Prosthetic valve incompetence was the commonest type to dysfunction observed because of tears, perforations, and even complete destruction of the cusps. Prosthetic valve stenosis following obstruction of the valve orifice by infected polypous masses was noted in two cases. Clumps of infective organisms were detected deep in the cusp tissue in most cases on histologic examination. infection located on the paraprosthetic tissues, associated with ring abscess, valve detachment, and insufficiency, was observed only once. According to the results of investigation, endocarditis on porcine bioprostheses is associated with a better preserved native valvular ring as viewed at reoperation. Therefore surgical intervention appears appropriate in the presence of severe hemodynamic complications after adequate antibiotic treatment. However, infection of these particular prostheses still carries an extremely high mortality. In the present series, this poor outcome might be explained by the frequently associated septic and thromboembolic events.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
10/11. Linear bacterial dissection.An unusual case of an erythematous indurated arcuate plaque with a curvilinear appearance was noted after a patient manipulated an ingrown beard hair. During removal of a biopsy specimen, a purulent discharge was expressed that had evidently dissected through the dermis forming this interesting shape. This may be similar to a recently reported entity described by Shelley and Shelley as linear bacterial dissection. culture of the discharge grew staphylococcus aureus and klebsiella pneumoniae. Complete resolution occurred after drainage and antibiotic therapy. cellulitis and erysipelas typically do not show central clearing or form arcuate plaques. Aside from lymphangitis, thrombophlebitis, and sinus tracts of carbuncles, dermal infectious processes rarely present as linear or arcuate plaques. The differential diagnosis and a review of the literature are presented.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
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