1/286. Late complications of Silastic duraplasty: low-virulence infections. Case report.The authors describe three patients with expanding hemorrhagic mass lesions who presented 13 to 18 years after undergoing Silastic duraplasty. In all patients, results of bacteriological cultures of the masses obtained intraoperatively were positive, revealing low-virulence bacteria. Two of the patients were treated with antibiotic drugs and made a good recovery. The third did not receive antibiotic medications initially and later developed an epidural empyema that necessitated reoperation, but subsequently made a complete recovery. Vascularized neomembranes are generally agreed to be causes of the expanding masses, but the possibility that patients could be harboring chronic infections must be considered. Thus, on removal of duraplasty materials a complete bacteriological culture should be obtained, and if it is positive the proper antibiotic therapy should be administered. Furthermore, the creation of a registry of patients who have received implants is advocated to facilitate tracking of implanted material in case of complications.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/286. The emergence of decreased susceptibility to vancomycin in staphylococcus epidermidis.BACKGROUND: coagulase-negative staphylococci (CNS) are the major cause of nosocomial bloodstream infection. Emergence of vancomycin resistance among CNS is a serious public health concern, because CNS usually are multidrug-resistant, and glycopeptide antibiotics, among which only vancomycin is available in the United States, are the only remaining effective therapy. In this report, we describe the first bloodstream infection in the united states associated with a staphylococcus epidermidis strain with decreased susceptibility to vancomycin. methods: We reviewed the hospital's microbiology records for all CNS strains, reviewed the patient's medical and laboratory records, and obtained all available CNS isolates with decreased susceptibility to vancomycin. blood cultures were processed and CNS isolates identified by using standard methods; antimicrobial susceptibility was determined by using minimum inhibitory concentration (MIC) and disk-diffusion methods. Nares cultures were obtained from exposed healthcare workers (HCWs) to identify possible colonization by CNS with decreased susceptibility to vancomycin. RESULTS: The bloodstream infection by an S. epidermidis strain with decreased susceptibility to vancomycin occurred in a 49-year-old woman with carcinoma. She had two blood cultures positive for CNS; both isolates were S. epidermidis. Although susceptible to vancomycin by the disk-diffusion method (16-17 mm), the isolates were intermediate by MIC (8-6 microg/mL). The patient had received an extended course of vancomycin therapy; she died of her underlying disease. No HCW was colonized by CNS with decreased susceptibility to vancomycin. CONCLUSIONS: This is the first report in the united states of bloodstream infection due to S. epidermidis with decreased susceptibility to vancomycin. Contact precautions likely played a role in preventing nosocomial transmission of this strain, and disk-diffusion methods may be inadequate to detect CNS with decreased susceptibility to vancomycin.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
3/286. Treatment of osteomyelitis by antibiotic impregnated porous hydroxyapatite block.A novel drug delivery system was developed for osteomyelitis using porous hydroxyapatite blocks (HA-b) that were impregnated with antibiotics by a centrifuge method. For the experimental study, a 10 mm3 HA-b was placed in a container, mixed with an antibiotic solution and centrifuged at 1500 rpm for 15 min for the purpose of impregnating antibiotics into the pores. The slow release activity of antibiotic (Arbekacin sulfate [1-N-(S)-4 amino-2-hydroxybutyryl dibekacin]) from the HA-b was tested. An evaluation was made of the slow-releasing capabilities of the ABK from HA-b which was still maintained at 0.5 microgram/ml within 21 exchanges of PBS after 42 days. Consequently, seven patients with osteomyelitis, including one with tuberculosis and two with infected hip arthroplasty, have been treated. On a follow-up study, all of the foci had completely healed by the end of the follow-up period without complications. This new method is simple and can be performed safety as a one-stage operation.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
4/286. Staphylococcus cohnii: a case report on an unusual pathogen.coagulase-negative staphylococci have become increasingly important causes of infection in predisposed hosts. such as patients receiving immunosuppressive therapy and broad-spectrum antimicrobial drugs, patients who have prosthetic devices, or those who have prolonged hospital or intensive care unit stays. However, human infections caused by Staphylococcus cohnii rarely have been reported in the literature. In this report, we review the current literature and describe a 38 year-old immunosuppressed woman who developed catheter-related S. cohnii bacteremia. The case illustrates why microbiology laboratories under certain circumstances should identify coagulase-negative staphylococci to the species level. This information may be critical because it may allow clinicians to identify the source of the infecting organism and to choose appropriate antibiotics. Yet in this era of cost containment many laboratories may decrease costs by decreasing services, including species identification.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
5/286. flatfoot and calcaneal deformity secondary to osteomyelitis after neonatal heel puncture.Deformity of the calcaneus was observed in three patients who developed osteomyelitis after neonatal heel puncture for newborn blood studies. Septic involvement of the calcaneal apophysis may produce an abnormal and early closure of this growth plate. Progressive deformity of the calcaneus, despite appropriate treatment, develops into an asymptomatic flatfoot. A strictly aseptic technique is mandatory for neonatal puncture of the heel to avoid this unusual complication. An infectious cause of flatfoot is proposed in this report.- - - - - - - - - - ranking = 0.16889484393744keywords = closure (Clic here for more details about this article) |
6/286. Treatment of skin and soft tissue infections with cefadroxil, a new oral cephalosporin.Oral cefadroxil in doses of 0-6-1-8 g per day given on twice or three times daily schedules was effective in the treatment of thirty-six patients with infections such as abscesses, carbuncles, cellulitis, furunculosis and impetigo. staphylococcus aureus strains and beta-haemolytic streptococci, alone or in combination, were cultured from lesions before treatment. in vitro studies with test discs showed that all the organisms were sensitive to cefadroxil, but twenty-three of twenty-nine S aureus strains and one of the seven streptococci strains were resistant to penicillin g. Pre- and post-treatment laboratory tests of renal, hepatic and haematopoietic functions produced no evidence of drug toxicity. The cefadroxil dosage effective in this study is lower than that recommended for currently available oral cephalosporins, which must be given on a four times daily schedule.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
7/286. Infective endocarditis on an occluder closing an atrial septal defect.Closure of atrial septal defects be means of intravenous catheterisation has been undertaken using a variety of devices as an alternative to surgical closure. We describe the first case, to the best of our knowledge, of infective endocarditis complicating a successful transcatheter closure. This highlights the potential risk of this procedure, and emphasises the need for appropriate antibiotic prophylaxis until complete endothelialization of the device has occurred.- - - - - - - - - - ranking = 0.33778968787488keywords = closure (Clic here for more details about this article) |
8/286. A comparison of dicloxacillin and ampicillin in the antibiotic prophylaxis of total hip replacement.The effect of two semi-synthetic penicillins, dicloxacillin and ampicillin was compared in systemic antibiotic prophylaxis in total hip replacement patients. The drugs were given in routine oral dosage for eight days to two patient groups each consisting of 50 patients. There was no fatality. In the ampicillin group there were three staphylococcal infections but no infections in the dicloxacillin group. Two of the infections occurred in reapplication cases leading to the loosening of the prosthesis. One infection appeared after a primary operation with a superficial recurrence 10 months later. In the ampicillin group, side effects were diagnosed in 12 cases and in the dicloxacillin group in one case.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
9/286. Arterial homografts in the management of infected axillofemoral prosthetic grafts.Two lower limb amputees with infected contralateral axillofemoral prosthetic grafts received preserved human arteries after removal of the infected materials. Both grafts grew organisms (enterococcus species, plus Staphylococcus species in one). Long length arterial conduits were fashioned from freshly harvested (in one patient) and cryopreserved (in another one) cadaveric iliac and femoral arteries. One arterial homograft had ABO-compatibility with the recipient. No immunosuppressive drugs were administered after repeat arterial reconstructions. After 12 and 15 months both grafts are still patent, without parietal changes at ultrasonography; the patients have a viable remaining lower extremity and are free of symptoms or re-infection.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
10/286. Primary sternal osteomyelitis and septicaemia due to staphylococcus aureus.Primary sternal osteomyelitis is rare in these recent decades. Only scattered cases have been reported, most of them in intravenous drug users. We report the case of an 88-y-old woman who presented a primary sternal infection due to staphylococcus aureus associated with secondary septicaemia. The only predisposing factor was radiotherapy for a malignant tumour of the right mammary gland 20 y ago. Diagnostic evaluation and therapeutic management are briefly discussed.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
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