Wednesday, October 31, 2012
Hyperbaric oxygenation for necrotizing soft tissue infections: pro.
Hyperbaric oxygenation for necrotizing soft tissue infections: pro.
Oct 2012
[Article in German]
Source
Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
Abstract
Necrotizing soft tissue infections are a complex pathological spectrum of symptoms and result in a significantly increased risk of mortality depending on the degree of dissemination as well as the underlying bacterial infection. Hyperbaric oxygen therapy (HBOT) can significantly improve the effectiveness of a multidisciplinary treatment concept consisting of surgical debridement, critical care and antibiotic treatment. HBOT itself assists solid wound healing by bactericidal and bacteriostatic effects and by increasing the oxygen supply up to the cellular level resulting in an optimization of oxygen-dependent metabolic processes. The efficacy of treatment in a centre of cooperating specialized departments can therefore be increased by utilizing HBOT as adjunct treatment. Nevertheless, if a HBOT facility is available, excluding HBOT is equivalent to omission of an effective therapy option to the disadvantage of patients.
Labels: antibiotic treatment, bacterial infection, critical care, HBOT, Hyperbaric oxygen therapy, necrotizing soft tissue infections, surgical debridement
# posted by Pat O'Connor @ 8:59 AM
Monday, October 29, 2012
Infections following the application of leeches: two case reports and review of the literature.
Infections following the application of leeches: two case reports and review of the literature.
Oct 2012
Abstract
ABSTRACT:
INTRODUCTION: Since the 1980s, leeches have been ingeniously used in the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being Aeromonas hydrophila and Aeromonas veronii biovar sobria, which contribute to the digestion of ingested blood. These bacteria can be the cause of infections.
CASE PRESENTATION:
We report two cases of septicemia related to Aeromonas veronii biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions. Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the sixth postoperative day she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment. Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of antibiotic treatment.
CONCLUSION:
The rate of infection after application of leeches is not negligible. The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones and resistant to amoxicillin/clavulanic acid. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the whole period of treatment by leeches.
Labels: amoxicillin, Antibiogram, antibiotic therapy, asepsis, blood, clavulanic acid, Infections, leeches, oral, skin, venous anticoagulative substances
# posted by Pat O'Connor @ 11:22 AM
Thursday, October 25, 2012
Postoperative infections in obstetrics and gynecology.
Postoperative infections in obstetrics and gynecology.
Dec 2012
Source
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
Abstract
Postoperative infection is the most commonly seen complication of surgery in obstetrics and gynecology. The use of antibiotic prophylaxis has greatly decreased though not completely eliminated this adverse outcome. Postoperative infections include wound cellulitis, wound abscess, endomyometritis, pelvic cellulitis, and pelvic abscess. Infections usually manifest as fever and greater than normal postoperative pain. Refractory fevers maybe because of septic pelvic vein thrombophlebitis or maybe noninfectious in origin. Broad-spectrum antibiotics should be initiated as soon as possible when diagnosis of postoperative infection is made; most patients will respond to treatment within 24 to 48 hours when appropriate antibiotics are selected.
Labels: antibiotics, endomyometritis, gynecology, Infections, obstetrics, pelvic abscess, pelvic cellulitis, postoerative, wound abscess, wound cellulitis
# posted by Pat O'Connor @ 7:52 AM
Sunday, October 21, 2012
Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis.
Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis.
Oct 2012
Source
The University of Edinburgh/MRC Centre for Research Inflammation, The Queen's Medical Research Institute, Edinburgh, UK.
Abstract
INTRODUCTION:
Vitamin-D deficiency has been linked to an increased risk of respiratory infections. The objective of this study was to determine the frequency and clinical importance of vitamin-D deficiency in patients with bronchiectasis.
METHODS:
25-hydroxyvitamin-D was measured by immunoassay in 402 stable patients with bronchiectasis. Patients were classified as vitamin-D deficient -serum 25-hydroxyvitamin-D less then 25 nmol/l, - insufficient - 25 nmol/l-74 nmol/l- or sufficient (≥75 nmol/l). Disease severity was assessed, including exacerbation frequency, measurement of airway inflammatory markers, sputum bacteriology and lung function over 3 years follow-up.
RESULTS:
Fifty percent of bronchiectasis patients were vitamin-D deficient, Forty three percent insufficient and onlyseven percent sufficient. This compared to only twelve percent of age and sex matched controls with vitamin-D deficiency. Vitamin-D deficient patients were more frequently chronically colonised with bacteria, twenty one point four percent of vitamin-D deficient subjects were colonised with Pseudomonas aeruginosa compared to ten point four percent of insufficient patients and Three point six percent of sufficient patients.. Vitamin-D deficient patients had lower FEV one percent predicted , and more frequent pulmonary exacerbations. Vitamin-D deficient patients had higher sputum levels of inflammatory markers and demonstrated a more rapid decline in lung function over 3 years follow-up. Defects in neutrophil function and assessment of airway LL-37 levels did not provide a mechanistic explanation for these findings. Vitamin-D deficient patients had, however, higher levels of Vitamin-D Binding Protein in sputum sol.
CONCLUSIONS:
Vitamin-D deficiency is common in bronchiectasis and correlates with markers of disease severity. The mechanism of this association is unclear.
Labels: airway inflammatory markers, bacterial colonisation, bronchiectasis, disease severity, lung function, Pseudomonas aeruginosa, sputum bacteriology, Vitamin-D deficiency
# posted by Pat O'Connor @ 8:56 AM
Helicobacter pylori serology in autoimmune diseases - fact or fiction?
Helicobacter pylori serology in autoimmune diseases - fact or fiction?
Oct 2012
Ram M, Barzilai O, Shapira Y, Anaya JM, Tincani A, Stojanovich L, Bombardieri S, Bizzaro N, Kivity S, Levin NA, Shoenfeld Y.
Abstract
Abstract Background: The pathogenesis of autoimmunity is presumed to be a complex process including genetic predisposition, hormonal balance and environmental factors such as infectious agents. Helicobacter pylori, a common bacterial infectious agent has been associated with a variety of autoimmune disorders. However, this bacteria is also thought to play a protective role in the development of multiple sclerosis (MS), systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD). We tested various links between anti-H. pylori (anti-HP) antibodies and a wide profile of autoimmune diseases and autoantibodies.
Methods: A total of 1290 patients diagnosed with 14 different autoimmune diseases from two geographical areas (Europe and Latin America) and two groups of healthy matching controls (n=385) were screened for the presence of H. pylori IgG antibodies by "pylori detect" kit. In parallel, a large profile belonging to three groups of autoantibodies was tested in all sera (anti-nuclear antibodies, autoantibodies associated with thrombophilia and gastrointestinal diseases).
Results: Our data demonstrate associations between anti-HP antibodies and anti-phospholipid syndrome, giant cell arteritis, systemic sclerosis and primary biliary cirrhosis. Our data also support a previously known negative association between the prevalence of anti-HP antibodies and IBD. Additionally, links were made between seropositivity to H. pylori and the presence of anti-nuclear antibodies, dsDNA, anti-Ro and some thrombophilia-associated antibodies, as well as negative associations with gastrointestinal-associated antibodies.
Conclusions: Whether these links are epiphenomenal or H. pylori does play a causative role in the autoimmune diseases remains uncertain. The negative associations could possibly support the notion that in susceptible individuals infections may protect from the development of autoimmune diseases.
Labels: anti-HP antibodies, autoimmune diseases, genetic predisposition, giant cell arteritis, Helicobacter pylori serology, infectious agents, phospholipid syndrome, primary biliary cirrhosis, systemic sclerosis
# posted by Pat O'Connor @ 8:51 AM
Monitoring Bacterial Burden, Inflammation and Bone Damage Longitudinally Using Optical and μCT Imaging in an Orthopaedic Implant Infection in Mice.
Monitoring Bacterial Burden, Inflammation and Bone Damage Longitudinally Using Optical and μCT Imaging in an Orthopaedic Implant Infection in Mice.
2012
Niska JA, Meganck JA, Pribaz JR, Shahbazian JH, Lim E, Zhang N, Rice BW, Akin A, Ramos RI, Bernthal NM, Francis KP,Miller LS.
Source
Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California, United States of America.
Abstract
BACKGROUND:
Recent advances in non-invasive optical, radiographic and μCT imaging provide an opportunity to monitor biological processes longitudinally in an anatomical context. One particularly relevant application for combining these modalities is to study orthopaedic implant infections. These infections are characterized by the formation of persistentbacterial biofilms on the implanted materials, causing inflammation, periprosthetic osteolysis, osteomyelitis, and bone damage, resulting in implant loosening and failure.
METHODOLOGY/PRINCIPAL FINDINGS:
An orthopaedic implant infection model was used in which a titanium Kirshner-wire was surgically placed in femurs of LysEGFP mice, which possess EGFP-fluorescent neutrophils, and a bioluminescent S. aureus strain (Xen29; 1×10(3) CFUs) was inoculated in the knee joint before closure. In vivo bioluminescent, fluorescent, X-ray and μCT imaging were performed on various postoperative days. The bacterial bioluminescent signals of the S. aureus-infected mice peaked on day 19, before decreasing to a basal level of light, which remained measurable for the entire 48 day experiment. Neutrophil EGFP-fluorescent signals of the S. aureus-infected mice were statistically greater than uninfected mice on days 2 and 5, but afterwards the signals for both groups approached background levels of detection. To visualize the three-dimensional location of the bacterial infection and neutrophil infiltration, a diffuse optical tomography reconstruction algorithm was used to co-register the bioluminescent and fluorescent signals with μCT images. To quantify the anatomical bone changes on the μCT images, the outer bone volume of the distal femurs were measured using a semi-automated contour based segmentation process. The outer bone volume increased through day 48, indicating that bone damage continued during the implant infection.
CONCLUSIONS/SIGNIFICANCE:
Bioluminescent and fluorescent optical imaging was combined with X-ray and μCT imaging to provide noninvasive and longitudinal measurements of the dynamic changes in bacterial burden, neutrophil recruitment and bone damage in a mouse orthopaedic implant infection model.
Labels: bacterial burden, Bioluminescent imaging, bone damage, fluorescent optical imaging, inflammation, periprosthetic osteolysi
# posted by Pat O'Connor @ 8:48 AM
Thursday, October 18, 2012
Plasmids and Bacterial Strains Mediating Multidrug-Resistant Hospital-Acquired Infections Are Coresidents of the Hospital Environment.
Plasmids and Bacterial Strains Mediating Multidrug-Resistant Hospital-Acquired Infections Are Coresidents of the Hospital Environment.
Oct 2012
Source
1 The ithree institute, University of Technology , Sydney, Australia .
Abstract
Hospital-acquired infections (HAIs) are a global problem. The widespread use of antibiotics continues to exacerbate the problem giving rise to antibiotic-resistant bacteria both in and outside a clinical context. The general hospital environment is an obvious important focus for the selection and spread of multiresistant bacteria and a potential direct source of HAIs. Despite this, there are few detailed studies that have investigated the relationship between strains mediating HAIs and strains coresident in the hospital.
Here we isolated bacteria from patients with HAIs exhibiting resistance to β-lactam antibiotics over a 1-month period in 2011. Three of these isolates were examined in detail by molecular analysis and their multiresistance regions were compared to β-lactam resistant bacteria isolated from the immediate hospital environment over the same period. All sampled patients were in a 14-bed burns unit and the environmental sample sites included shower drains, sinks, trolleys, and door handles. It was found that identical strains carrying the same resistance regions were present in both patients and the hospital environment suggesting HAIs can arise from bacteria resident in the immediate surrounds.
The three patientinfections were not derived from a single source, since strains could be distinguished by the genotype and spatial location. While it seems unlikely that eradication of multiresistant bacteria from the hospital can be achieved, more effective hospital cleaning and a better hospital design may be able to reduce transmission.
Labels: Bacterial Strains, Hospital Environment, hospital-acquired infections, Multidrug-Resistant, Plasmids
# posted by Pat O'Connor @ 7:31 AM
Meningococcal disease: changes in epidemiology and prevention.
Meningococcal disease: changes in epidemiology and prevention.
Source
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Abstract
The human bacterial pathogen Neisseria meningitidis remains a serious worldwide health threat, but progress is being made toward the control of meningococcal infections. This review summarizes current knowledge of the global epidemiology and the pathophysiology of meningococcal disease, as well as recent advances in prevention by new vaccines. Meningococcal disease patterns and incidence can vary dramatically, both geographically and over time in populations, influenced by differences in invasive meningococcal capsular serogroups and specific genotypes designated as ST clonal complexes. Serogroup A (ST-5, ST-7), B (ST-41/44, ST-32, ST-18, ST-269, ST-8, ST-35), C (ST-11), Y (ST-23, ST-167), W-135 (ST-11) and X (ST-181) meningococci currently cause almost all invasive disease. Serogroups B, C, and Y are responsible for the majority of cases in Europe, the Americas, and Oceania; serogroup A has been associated with the highest incidence (up to 1000 per 100,000 cases) and large outbreaks of meningococcal disease in sub-Saharan Africa and previously Asia; and serogroups W-135 and X have emerged to cause major disease outbreaks in sub-Saharan Africa. Significant declines in meningococcal disease have occurred in the last decade in many developed countries. In part, the decline is related to the introduction of new meningococcal vaccines. Serogroup C polysaccharide-protein conjugate vaccines were introduced over a decade ago, first in the UK in a mass vaccination campaign, and are now widely used; multivalent meningococcal conjugate vaccines containing serogroups A, C, W-135, and/or Y were first used for adolescents in the US in 2005 and have now expanded indications for infants and young children, and a new serogroup A conjugate vaccine has recently been introduced in sub-Saharan Africa. The effectiveness of these conjugate vaccines has been enhanced by the prevention of person-to-person transmission and herd immunity. In addition, progress has been made in serogroup B-specific vaccines based on conserved proteins and outer membrane vesicles. However, continued global surveillance is essential in understanding and predicting the dynamic changes in the epidemiology and biological basis of meningococcal disease and to influence the recommendations for current and future vaccines or other prevention strategies.
Labels: conjugate vaccines, epidemiology, Meningococcal disease, meningococcal vaccines, Neisseria meningitidis, prevention
# posted by Pat O'Connor @ 7:28 AM
