Antibiotic Era Research Articles

Management of brain abscesses associated with halo fixation

Halo orthoses are commonly used in the management of a variety of cervical spinal pathological conditions. Although placement of the cranial pins was initially believed to be safe with minimal complications, minor complications related to the cranial pins have the potential to create a setting for formation of cerebral abscesses. The risk of death due to cerebral abscesses has declined in the modern antibiotic era, but cerebral abscesses are associated with long-standing neurological morbidity that should not be considered negligible. Prevention by careful pin placement and hygiene and appropriate early management are crucial to prevent more serious complications. The authors report the case of a patient treated with a halo orthosis after incurring cervical spinal trauma who developed a cerebral abscess as a complication related to the cranial pins of the halo fixation device. They review the literature in an attempt to formulate a standardized treatment algorithm to prevent this disease process and to treat an abscess if it should form.

Sepsis: Time has come to focus on the later stages

Despite numerous advances in intensive care medicine, sepsis remains a deadly disease. Today, conventional therapeutic approaches and mainstream scientific research mostly focus on symptomatic early goal directed organ support therapy. This includes fluid resuscitation, choice and timing of antibiotics and vasopressors, mechanical ventilation, and renal replacement strategies. Furthermore, great effort has been undertaken to investigate whether tightly controlled blood glucose levels, the application of corticosteroids, and early medication using activated protein C improves survival. However, most of these mainstream approaches have recently been shown unsuccessful in large-scale clinical trials. Current data now suggest that besides giving fluids, antibiotics, and symptomatic organ support, little - if at all - can be done to improve mortality from sepsis. This might be due to the fact that in the presence of modern intensive care medicine, most patients with severe sepsis or septic shock will survive the early "shock phase" of the disease. Mounting evidence suggests that in the course of the disease, most septic patients are then subjected to a secondary phase, which is characterised by a failure of cell-mediated immunity. This leads to repeated and uncontrolled infections, "chronic" multiple organ failure, and death in a large number of cases. Here we hypotheses that in order to profoundly influence survival from sepsis, future therapeutic efforts in the field should concentrate on this later "hypo-immune" stage of sepsis, associated immune phenomena, and novel immunomodulatory strategies. This may lead to the development of advanced immunomodulatory therapies available for widespread clinical use. Today, in the era of antibiotics and advanced organ system support therapy, it is not the bug that kills you- survival has become a matter of whether your cellular immune system can cope.

Tuberculosis in Africa — Combating an HIV-Driven Crisis

Africa is facing the worst tuberculosis epidemic since the advent of the antibiotic era. Drs. Richard Chaisson and Neil Martinson write that the unprecedented growth of the epidemic is attributable to several factors, the most important being the HIV epidemic.

Get Well—Then (Maybe) Get Rich

Get Well—Then (Maybe) Get Rich

Internal jugular vein thrombosis in a case of attico antral disease - a rare presentation in this modern antibiotic era.

We report a case of Internal Jugular Vein Thrombosis with a long segment thrombus in a clinical setting of attico antral type of Chronic Suppurative Otitis Media (CSOM) in a 20 year male. He presented with hectic rise of temperature with chills & rigor of 7 days duration associated with left ear discharge & throbbing headache of 10 days duration. ENT examination revealed attico antral type of Chronic suppurative Otitis Media with sinus thrombophlebitis. Further investigations revealed a mural thrombus extending from the lower part of Internal Jugular Vein (IJV) till the Torcula Herophili. Left Modified radical mastoidectomy with exposure of transverse & sigmoid sinus was done to completely eradicate the disease and source of infection. The patient was treated with oral anticoagulants and parenteral antibiotics based on the sensitivity report and became asymptomatic after 8 weeks.

Howard Florey and research on the cerebral circulation

Howard Florey is best known as the scientist who developed penicillin and ushered in the modern antibiotic era. As an experimental pathologist he founded one of the leading schools of experimental pathology at Oxford and his achievements established him as one of the foremost medical scientists of the twentieth century. Florey’s ambition and drive toward medical research commenced in the years 1922–1925 when he was a Rhodes scholar at Oxford. His mentor was the neurophysiologist and Nobel Laureate, Sir Charles Sherrington who directed him in neuroscience research. Florey’s initial studies on the cerebral circulation represent an original contribution to medical knowledge and highlight his remarkable scientific method. The mentorship and close personal relationship with Sherrington was a crucial factor in Florey’s early research career.

Purulent pericarditis

Bacterial pericarditis has become a clinical rarity since the onset of antimicrobial therapy, yet remains fatal in a large majority of cases. We present the case of a 57-year-old male, admitted with a short history of pleuritic chest pain and dyspnoea. Investigations led to diagnosis of pyopericardium, most likely secondary to fistulating thoracic malignancy. Despite maximum medical treatment this condition proved fatal. This case highlights the still unfortunately poor prognosis of purulent pericarditis in the antibiotic era. Underlying aetiological factors should be searched for and eliminated where possible when a diagnosis of purulent pericarditis is made.

Staphylococcus aureus

Staphylococcus aureus is one of the major bacterial pathogens of man, causing a variety of diseases from mild skin and soft-tissue infections to severe invasive infections with high mortality. In the healthcare setting it is the most frequent cause of surgical site, lower respiratory tract and cardiovascular infections and the second most common cause of blood stream infections and pneumonia. The ability of S. aureus to develop resistance to all classes of antimicrobials, in particular the �-lactams, has become a major global problem. In the pre-antibiotic era, the mortality rate for severe staphylococcal sepsis was as high as 90%. In a recent meta-analysis of nine studies of S. aureus bacteraemia in the antibiotic era, although the mean mortality rate due to methicillin-susceptible S. aureus (MSSA) was 12% (ranging from 0 to 38%), for methicillin-resistant S. aureus (MRSA) the mean was 29% (ranging from 8 to 50%). Whilst estimates vary, the mortality associated with MRSA is on average twice that with MSSA.

Inner ear and facial nerve complications of acute otitis media, including vertigo

Acute otitis media is one of the most common diagnoses made in children in the United States. Intracranial and extracranial (intratemporal) complications have greatly decreased in the antibiotic era, but still remain a challenge when they arise. This article addresses two intratemporal complications with significant associated morbidity: facial nerve paralysis/paresis, and labyrinthitis. Epidemiology, pathology, clinical diagnosis, and treatment options are discussed, focusing on an evidence-based approach to diagnosis and management. In addition, the future of treatment and current questions regarding otitis media are briefly discussed.

Descending necrotizing mediastinitis

From January 1975 through July 1981, ten patients with mediastinitis complicating an oropharyngeal infection, that is, a form of mediastinitis best termed as DNM, were encountered at our institution. Based upon rather relatively stringent diagnostic criteria, 21 other instances were found in the literature from 1960 to 1980, a time period well into the antibiotic era. The predominant underlying oropharyngeal infection was of odontogenic origin, specifically, infection involving the mandibular molars. Bacteriologically, DNM is most frequently a polymicrobial process, with anaerobes playing a major role. Although there has been a decline in the over-all incidence of DNM since the introduction of antibiotics, its morbid and lethal nature persists, as evidenced by the present prohibitive mortality of approximately 42 per cent. Delayed diagnosis and inadequate drainage procedures are the primary underlying factors contributing to this high mortality. At present, CT scan is the single most important tool for the early diagnosis of DNM. This noninvasive procedure also helps determine the adequacy of the surgical drainage procedure performed. However, with all the presently available diagnostic tools, it is still the high index of suspicion by physicians toward patients with unrelenting oropharyngeal or deep neck infection that is of utmost importance for making an early diagnosis of DNM. In view of our experience and that of others, we believe that only through aggressive combined medical and surgical management can the highly morbid, if not lethal, course of DNM be reversed. It should be emphasized that, to accomplish successful operative intervention, a thorough knowledge of the complex anatomy of the region is crucial.

Silent victories: the history and practice of public health in twentieth-century America

SECTION 1 - CONTROL OF INFECTIOUS DISEASES 1. Control of Infectious Diseases - A 20th Century Public Health Achievement 2. Advances in Food Safety to Prevent Foodborne Diseases in the United States 3. A Brief Romance with Magic Bullets: Rene' Dubos at the Dawn of the Antibiotic Era SECTION 2 - CONTROL OF DISEASE THROUGH VACCINATION 4. A Shot at Protection: Immunizations Against Infectious Disease 5. Polio Can Be Conquered: Science and Health Propaganda in the United States from Polio Polly to Jonas Salk SECTION 3 - MATERNAL AND INFANT HEALTH 6. Safe Mothers, Healthy Babies: Reproductive Health in the 20th Century 7. Pioneering Efforts to Decrease Infant and Maternal Mortality SECTION 4 - NUTRITION 8. The Impact of Improved Nutrition on Disease Prevention 9. The More Things Change, ...: A Historical Perspective on the Debate over Vitamin Advertising in the United States SECTION 5 - OCCUPATIONAL HEALTH 10. Safer, Healthier Worker: Advances in Occupational Disease and Injury Prevention 11. A Prejudice that May Cloud the Mentality: The Making of Objectivity in Early Twentieth-Century Occupational Health (A study of the Progressive Era origins of occupational medicine) SECTION 6 - FAMILY PLANNING 12. Family Planning: A Century of Change 13. Teaching Birth Control on Tobacco Road and Mill Village Alley: Race, Class, and Birth Control in Public Health SECTION 7 - ORAL AND DENTAL HEALTH: FLUORIDATION 14. Changing the Face of America: Water Fluoridation and Oral Health 15. The Task is a Political One: The Promotion of Fluoridation SECTION 8 - VEHICULAR SAFETY 16. Drivers, Wheels and Roads: Motor Vehicle Safety in the 20th Century 17. The Nut Behind the Wheel: Shifting Responsibilities for Traffic Safety Since 1895 SECTION 9 - CARDIOVASCULAR DISEASE 18. Heart Disease and Stroke Mortality in the 20th Century 19. Dietary Policy, Controversy and Proof: Doing Something Versus Waiting for the Definitive Evidence SECTION 10 - TOBACCO AND DISEASE PREVENTION 20. Thank You for Not Smoking: The Public Health Response to Tobacco Related Mortality in the United States 21. The First Surgeon Generals Report on Tobacco: Science and the State in the New Age of Chronic Disease SECTION 11 - CONCLUDING CHAPTER 22. Public Health at the Dawn of the 21st Century

Pott Puffy Tumor in a 4-Year-Old Boy Presenting in Status Epilepticus

Pott puffy tumor is an osteomyelitis of the frontal bone with the development of a subperiosteal abscess manifesting as a puffy swelling of the forehead or scalp. It is believed to occur as a complication of frontal sinusitis. The modern antibiotic era has made it a rarely encountered entity. This case describes a 4-year-old boy who presented in status epilepticus secondary to Pott puffy tumor.

Nosocomial infections: Dharwad review

Patients are no doubt better treated in hospitals than anywhere else; however, congregating a large number of sick under a single roof could easily facilitate the transmission of infectious diseases from one patient to another. To say that nosocomial infections are of great importance in hospitalized patients is to state the obvious. Nosocomial infections, even in this modern era of antibiotics continue to remain an important and formidable consequence of hospitalization. This presentation analyses the incidence, aetiology, predisposing factors, microbiology and management of nosocomial infections in patients treated in our unit from the year 1997 to 2006 and the steps taken to prevent it.

OXA-type β-lactamases in Acinetobacter baumannii: emerging from the shadow of the extended-spectrum β-lactamases

The extended-spectrum β-lactamases have evolved owing to the extensive use of the oxyimino-cephalosporins, and have greatly reduced the treatment options for serious infections. Acinetobacter baumannii is becoming an increasingly important multiresistant nosocomial pathogen due to the carriage of class D OXA-type β-lactamases. The OXA-23-like, OXA-40-like and OXA-58-like β-lactamases confer carbapenem resistance and are increasingly being found in association with a diversity of mobile genetic elements. High prevalence of OXA-40-like enzymes on the Iberian Peninsula, OXA-58-like enzymes across Europe and very high prevalence of OXA-23-like enzymes in South America and Asia are of concern. The intrinsic OXA-51-like enzymes of A. baumannii may confer carbapenem resistance when overexpressed, and form a large enzyme family. Similar patterns are beginning to be seen for the OXA-type β-lactamases, which were previously seen in the emergence of the extended-spectrum β-lactamases, the continuation of which would pose a grave threat to the antibiotic era.

Abscess of the deep cervical fascial space in adults: A report of 3 cases and review of anatomy

Deep cervical space abscess is a disease with the potential for grave consequences if not managed properly. Even though since the antibiotic era it has been on the decline, it still occurs. Better imaging techniques have made the management of this disease better such that it is possible to treat the abscesses conservatively reserving surgical drainage for cases that fail to respond to treatment. We present 3 cases of deep cervical space abscess that were surgically drained and wide spectrum antibiotic administered. In one of the patients, there was coexisting pulmonary tuberculosis.

Rapid spread of methicillin-resistant Staphylococcus aureus in a new hospital in the broad-spectrum antibiotic era

It has been known that it takes a long time for methicillin-resistant Staphylococcus aureus (MRSA) to introduce and become endemic within a hospital. During the last decade, widespread use of broad-spectrum antibiotics might have affected the time required for MRSA to spread and become endemic in hospitals. However, there has been no report on this issue. We investigated how fast MRSA has spread and become endemic in a hospital opened in the broad-spectrum antibiotic era. The study was performed at a Korean hospital, which opened in 1999. We examined the change of antimicrobial susceptibility and antimicrobial use density (AUD) for 6 years since hospital opening. S. aureus susceptibility to oxacillin decreased from 64% in the first month to 33% in the second month (P=.05), and then has maintained around 30%. AUD was remarkably high from the first year, in which total AUD and those of aminopenicillins, second-generation cephalosporins, fluoroquinolones, and macrolides were 4674.6, 1444.6, 1700.9, 421.3, and 520.0 DDD/1000 patient-days, respectively. MRSA has spread within a few months in a hospital opened in the broad-spectrum antibiotic era. Excessively high use of broad-spectrum antibiotics seems to be responsible for rapid spread of MRSA in the hospital.

Sonographic appearance of a postpartum pyomyoma with gas production

Pyomyoma or suppurative leiomyoma is a potentially fatal complication of uterine leiomyomas. It is a rare condition with only a small number of reported cases since the era of antibiotics, and the descriptions of its sonographic appearance has been limited. We present a case of a pyomyoma associated with gas production, including a brief review of the reported sonographic features.

Global Challenge of Multidrug-ResistantAcinetobacter baumannii

We may soon be facing the end of the “antibiotic era.” The initial and seemingly unstoppable success of antibiotics, the fruit of human ingenuity, has been countered by an escalation of resistance mechanisms in bacteria. This crisis has been described as an “unwinnable war” (www.wellcome.org). The statistics compiled as a result of surveillance efforts illustrate the emergence of many genera of bacteria that are resistant to all antibiotics (57, 60). The genus Acinetobacter epitomizes this trend and deserves close attention. Acinetobacter spp. display mechanisms of resistance to all existing antibiotic classes as well as a prodigious capacity to acquire new determinants of resistance (7). The increasing recovery in the clinic of multidrug-resistant (MDR) Acinetobacter baumannii is a frightening reality (112). This review summarizes the worldwide emergence of antibiotic-resistant A. baumannii as a nosocomial pathogen and focuses on its mechanisms of resistance against selected antibiotics. It concludes with a summary of current strategies in the treatment of MDR A. baumannii and offers perspectives on the control of this global public health threat.

A second large plasmid encodes conjugative transfer and antimicrobial resistance in O119:H2 and some typical O111 enteropathogenic Escherichia coli strains.

A novel and functional conjugative transfer system identified in O119:H2 enteropathogenic Escherichia coli (EPEC) strain MB80 by subtractive hybridization is encoded on a large multidrug resistance plasmid, distinct from the well-described EPEC adherence factor (EAF) plasmid. Variants of the MB80 conjugative resistance plasmid were identified in other EPEC strains, including the prototypical O111:NM strain B171, from which the EAF plasmid has been sequenced. This separate large plasmid and the selective advantage that it confers in the antibiotic era have been overlooked because it comigrates with the virulence plasmid on conventional gels.

Confronting infection in the English National Health Service

It is exactly 160 years since Ignac Semmelweis was removed from his post as lecturer in obstetrics in Vienna for introducing hand decontamination for medical students between the autopsy room and the delivery suite. Fortunately, he was later reinstated and then was able to continue his pioneering work as Professor of Obstetrics in Budapest. Yet even now the challenge of healthcare associated infections (HCAI) for the NHS in England is represented by over 7000 reports of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia in each of the five years since mandatory surveillance was instituted in 2001, and by mandatory surveillance of Clostridium difficile associated diarrhoea showing over 44,000 cases in 2004 and nearly 52,000 cases in 2005 in patients over 65 years old. The programme to address HCAI in the NHS in England is one of biology, politics, and performance management, which are not always comfortable partners. The first 100 years of the modern medical era, since the time of Pasteur and Semmelweis, established initially that microbes caused disease. This was followed by the work on antiseptics by Lister and the development of aseptic practice. Prevention also came with vaccine development and then there was a stuttering start to the era of antibiotic and chemotherapy in the early twentieth century. In 1941 we entered the antibiotic era and a period of great success and euphoria which led to the view encapsulated by the Surgeon General of