Course Of Intravenous Antibiotics Research Articles

Reducing IV Antibiotic Duration for Neonatal UTI Using a Clinical Standard Pathway.

Urinary tract infections (UTIs) are the most common bacterial infections in young infants and are traditionally treated with longer intravenous (IV) antibiotic courses. A growing body of evidence supports shorter IV antibiotic courses for young infants. Our primary aim was to decrease the IV antibiotic treatment to 3 days over 2 years for neonates aged 0 to 28 days who have been hospitalized with UTIs. Using quality improvement methods, our primary intervention was to implement a revised clinical pathway recommending 3 (previously 7) days of IV antibiotics. Our primary outcome measure was IV antibiotic duration, and the secondary outcomes were length of stay (LOS) and costs. The balancing measure was readmission within 30 days of discharge. Neonates were identified by using International Classification of Diseases diagnosis codes and excluded if they were admitted to the ICU or had a LOS >30 days. We used statistical process control to analyze outcome measures for 4 years before (baseline) and 2 years after the pathway revision (intervention) in February 2020. A total of 93 neonates were hospitalized with UTIs in the baseline period and 41 were hospitalized in the intervention period. We found special cause variation, with a significant decrease in mean IV antibiotic duration from 4.7 (baseline) to 3.1 days (intervention) and a decrease in mean LOS from 5.4 to 3.6 days. Costs did not differ between the baseline and intervention periods. There were 7 readmissions during the baseline period, and 0 during the intervention period. The implementation of a revised clinical pathway significantly reduced IV antibiotic treatment duration and hospital LOS for neonatal UTIs without an increase in hospital readmissions.

Outpatient parenteral antibiotic treatment for infective endocarditis: A retrospective observational evaluation

BackgroundInfective endocarditis (IE) requires long courses of intravenous (IV) antibiotics. Outpatient parenteral antibiotic therapy (OPAT) saves resources, improves the patient experience and allows care in their preferred place; however, questions remain about safety when treating IE patients. This study evaluates OPAT management of IE patients in our region between 2006 and 2019. MethodsThis is a retrospective observational evaluation and description of outcomes and adherence to suitability criteria, according to British Society for Antimicrobial Chemotherapy (BSAC) guidelines. ResultsWe identified five models of OPAT delivery. The number of patients treated expanded significantly over time. Of 101 patients, six (6%) suffered poor outcomes, but each patient had contributing factors outside of the primary infection. Median OPAT duration was 12 days and 1,489 hospital bed days were saved. ConclusionsIn a setting where there was good adherence to BSAC criteria, treating IE patients using OPAT services was safe. Complications observed were likely independent of treatment location. Significant bed days were saved.

Delayed Infection After Cervical Disc Arthroplasty: A Case Report and Review of the Literature.

Case report and literature review. To report the relatively rare complication of delayed infection after cervical disc arthroplasty (CDA). Delayed infection of the M6 device has been a rarely reported complication, with all cases described outside of the United States. The reliability of positive intraoperative cultures remains an ongoing debate. Cases were reviewed, and findings were summarized. A literature review was performed and discussed, with special consideration to current reports of delayed M6 infection, etiology, and utility of intraoperative cultures. We present a case of delayed infection 6 years after primary 1-level CDA with the M6 device. At revision surgery, gross purulence was encountered. Intraoperative cultures finalized with Staphylococcus epidermidis and Cutibacterium acnes. The patient was revised with removal of the M6 and conversion to anterior cervical discectomy and fusion. A prolonged course of intravenous antibiotics was followed by an oral course for suppression. At the final follow-up, the patient's preoperative symptoms had resolved. Delayed infection after CDA is a rare complication, with ongoing debate regarding the reliability of positive cultures. We describe an infected M6 and demonstrate the utility of implant removal, conversion to anterior cervical discectomy and fusion, and long-term antibiotics as definitive treatment. Level V-case report and literature review.

Clinical Outcomes of Delayed Laparoscopic Cholecystectomy in Patients with Acute Calculous Cholecystitis: A Single Centre Study

Background: A delayed laparoscopic cholecystectomy is performed as an elective procedure several weeks after a conservative treatment which involves a course of intravenous antibiotics. Aims: To evaluate the clinical outcomes (i.e. hospital stay, mean operative time, re-admissions, and conversion) of delayed laparoscopic cholecystectomy among patients with acute calculous cholecystitis operated on in a tertiary care hospital. Methods: A six-month retrospective study was conducted at the Department of Surgery, Saint Luke’s General Hospital, Kilkenny, Ireland, from 28th August, 2017, to 1st March, 2018. It included 148 patients with acute calculous cholecystitis who underwent delayed laparoscopic cholecystectomy in the department from January, 2016 to December 2016 and who satisfied the inclusion and exclusion criteria. The data was analyzed using SPSS version 21. The age range of patients was between 26 and 59 years, and the overall mean (±SD) age of patients was 41.67 (± 8.23) years. The majority (59.5%) of patients enrolled were aged over 40 years. Among the 148 patients enrolled in this study, 34 (23%) were males and 114 (77%) were females. Only eight (5.4%) patients were converted to open cholecystectomy, and readmission was observed in 21.6% patients. The mean (SD) length of stay was 5.59 (4.42), while the mean length of operative duration was 107.69 (32.15) respectively. Conclusion: Delayed laparoscopic cholecystectomy among patients with acute calculous cholecystitis produces a significantly lower likelihood of conversion to open surgery.

A202 A CASE OF MYCOBACTERIUM WOLINSKYI PULMONARY INFECTION SECONDARY TO LONG-STANDING ACHALASIA IN AN IMMUNOCOMPETENT PATIENT

Abstract Background Achalasia is an esophageal motility disorder resulting in chronic esophageal obstruction and stasis. Rapidly growing mycobacterium (RGM) pulmonary infections have been previously observed in individuals with underlying gastro-esophageal motility disorders. To date, pulmonary Mycobacterium wolinskyi infection (MWI) in the setting of achalasia has not previously been reported. Aims Our aim is to present a novel case of M. wolinskyi pneumonia in a patient with achalasia. We also searched the medical literature to identify previously reported associations between achalasia, chronic regurgitation symptoms and MWI. M. wolinskyi is an emerging clinical concern among RGMs. While primarily associated with post-operative, prosthetic joint and skin and soft tissue infections, M. wolinskyi pulmonary infections have not been documented to date in an immunocompetent patient. Methods We present a retrospective clinical case description of our case. We carried out a literature review from 1999 to Oct 2023, with the keywords "M. wolinskyi and infection. Results A 34-year-old male presented with a several-month history of productive cough, exertional dyspnea, fatigue, and unintentional weight loss of 17 kg over the past 6 months. Despite multiple courses of oral and intravenous antibiotics, there was no clinical improvement. His medical history included long-standing achalasia requiring previous pneumatic dilations. On admission, his chest X-ray revealed bilateral interstitial and alveolar infiltrates with consolidation. Routine microbiology and viral panels were negative. CT scan showed widespread bilateral consolidation and a dilated and fluid-filled esophagus. A timed barium swallow demonstrated dilated esophagus with irregular tertiary contractions and limited GE-J opening. Sputum cultures were positive for MWI on day 8 of admission (BACTEC MGIT). This was confirmed with lung biopsy demonstrating MWI with necrotizing granulomatous inflammation. The patient was prescribed a 12-month course of doxycycline, trimethoprim-sulfamethoxazole, and ciprofloxacin. Inpatient pneumatic dilation to 35 mm was performed. At discharge, his swallowing was subjectively improved, and a follow-up swallowing study noted improvement with no evidence of regurgitation. Conclusions Chronic esophageal obstruction provides an ideal lipid-rich environment for RGM infections. Related mycobacterial species have been isolated in pulmonary infections have been linked to chronic esophageal obstruction. To date, no cases of M. wolinskyi pulmonary infection with achalasia have been reported. We present a unique case of M. wolinskyi pulmonary infection in an immunocompetent patient with chronic achalasia, adding to our understanding of this emerging clinical concern. Funding Agencies None

An Innovative Therapy by Changing the Gut Microbiome for the Dual Post-Operative Complications of the Recurrent Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in the Residual Type II First Branchial Cyst and Facial Nerve Palsy

A very unusual, interesting, and challenging case of a 24-year-old female who was born with three openings in the neck. The patient had chronic abdominal gaseous distention, recurrent abdominal pain, and constipation since early infancy. The patient presented in emergency with acute painful red, hot, and tender swelling in the left upper cervical area. Laboratory studies showed high inflammatory markers and a provisional diagnosis of abscess with a sinus was made. The patient underwent an emergency incision and drainage. Sinus recurred and a sinogram showed it to be a residual cyst in the left submandibular salivary gland. The total cyst excision was attempted with resultant recurrence and grade IV facial nerve palsy. Post-operatively recurrent infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) required several courses of oral and intravenous broad-spectrum antibiotics with several hospital admissions with no resolution in sight. Subsequent ultrasound and magnetic resonance imaging showed a residual infected cyst, cutaneous sinus, and a fistula opening in the left ear canal. A diagnosis of branchial cyst type II of the first brachial cleft remnant with a fistula was established with bilateral branchial fistulas of the second branchial remnants and the associated colorectal hypoganglionosis based on radiological studies. The patient refused any further operative interventions. Therefore, the option of conservative treatment of hypoganglionosis with holobiotics consisting of prebiotics, probiotics and postbiotics, laxatives, dietary changes, lifestyle modifications, and dietary supplements started. All antibiotics were stopped. These therapies resulted in the resolution of residual first branchial remnants and recurrent MRSA infections with the improvement in the facial nerve palsy from grade IV to grade III-IV together with an excellent cosmetic and functional result. The patient is doing well at follow-ups being infection-free for 18 months and repeat contrast-enhanced computed tomogram (CECT) has shown complete resolution of the residual cyst, sinus, and fistula with fibrosis.

A Review of the Clinical Utilization of Oral Antibacterial Therapy in the Treatment of Bone Infections in Adults.

Chronic osteomyelitis in adults is managed with prolonged courses of intravenous antibiotics in conjunction with surgical debridement of necrotic bone. Over the past 40 years, there has been no paradigm shift in this approach, as randomized controlled trials of this standard of care compared to alternatives such as prolonged oral antibiotics are scarce. However, there have been many small trials, case reports, and review papers evaluating the effectiveness of oral treatment for chronic osteomyelitis. The oral route for infections requiring prolonged treatment is intuitively and practically more favorable due to several advantages, the most important of which is the avoidance of long-term IV antimicrobial therapy with its complications, inconvenience, and cost. In this paper, we review the literature evaluating oral antibiotic therapy in the management of chronic bone infections since 1975. The majority of osteomyelitis infections are caused by Staphylococcus aureus, hence we focus on its treatment using oral antibiotics; however, we also emphasize subpopulations of patients with diabetes, implanted hardware, and with less common bacterial organisms. The primary objective of this review is to promulgate clinical recommendations on the use of oral antibiotics in bone infections in the context of initial therapy, transition from intravenous therapy, and the role of chronic suppression. The secondary objective is to summarize current knowledge of the specific oral antimicrobial agents that are commonly utilized, together with a synopsis of the available literature pertaining to their pharmacokinetic/pharmacodynamic properties and duration of therapy in bone infection.

Utilization of Antibiotic Bone Cement in Spine Surgery: Pearls, Techniques, and Case Review.

Vertebral osteomyelitis (VO) encompasses a spectrum of spinal infections ranging from isolated mild vertebral osteomyelitis to severe diffuse infection with associated epidural abscess and fracture. Although patients can often be treated with an initial course of intravenous antibiotics, surgery is sometimes required in patients with sepsis, spinal instability, neurological compromise, or failed medical treatment. Antibiotic bone cement (ABC) has been widely used in orthopedic extremity surgery for more than 150 years, both for prophylaxis and treatment of bacterial infection. However, relatively little literature exists regarding its utilization in spine surgery. This article describes ABC utilization in orthopedic surgery and explains the technique of ABC utilization in spine surgery. Surgeons can choose from multiple premixed ABCs with variable viscosities, setting times, and antibiotics or can mix in antibiotics to bone cements themselves. ABC can be used to fill large defects in the vertebral body or disc space or in some cases to coat instrumentation. Surgeons should be wary of complications such as ABC extravasation as well as an increased difficulty with revision. With a thorough understanding of the properties of the cement and the methods of delivery, ABC is a powerful adjunct in the treatment of spinal infections.

Advancements In Diagnostics, Treatments and Precision Medicines of Lyme Diseases – A Review

The incidence of Lyme disease, which is caused by the bacteria Borrelia burgdorferi and is transmitted by ticks in 77% of cases, has significantly increased. Skin rashes, neurological, dermatological, cardiovascular, and musculoskeletal problems are all brought on by the illness. Ten to twenty percent of individuals with post-treatment Lyme disease syndrome (PTLDS) do not improve after receiving treatment. It is essential to comprehend the traits of Borrelia burgdorferi in order to create Lyme disease diagnostic equipment and treatments. Since North America has the highest prevalence of infected black-legged ticks, the disease is spread by their bite. Preventing health issues requires early detection and treatment. Lyme disease is diagnosed using diagnostic methods such as PCR, qPCR, RT-PCR, NAATs, NGS, and multiplex PCR panels. Lyme arthritis treatment, longer courses of oral antibiotics, intravenous antibiotics, and post-treatment Lyme disease syndrome are among the treatments available. Precision medicine, also known as customized medicine, tries to modify medical judgments and treatments for specific patients in light of their distinctive genetic makeup, way of life, and environment. The future treatment of Lyme disease will comprise better diagnostic equipment, sophisticated imaging methods, precision medicine, individualized vaccination plans, and patient-centered research.

Situs Ambiguus Is Associated With Adverse Clinical Outcomes in Children With Primary Ciliary Dyskinesia

BackgroundPrimary ciliary dyskinesia (PCD) is a rare disorder of motile cilia associated with situs abnormalities. At least 12% of patients with PCD have situs ambiguus (SA), including organ laterality defects falling outside normal arrangement [situs solitus (SS)] or mirror image inversion [situs inversus totalis (SIT)]. Research QuestionDo patients with PCD and SA have worse clinical outcomes compared to those with SS or SIT? Study Design and MethodsThis cross-sectional, multicenter study evaluated participants ≤21 years with PCD. Participants were classified as SA, including heterotaxy, or non-SA (SS or SIT). Markers of disease severity were compared between situs groups, adjusting for age at enrollment and severe CCDC39/CCDC40 genotype, using generalized linear models, logistic and Poisson regression. ResultsIn 397 participants with PCD (mean age 8.4 years, range 0.1-21), 42 were classified as SA, including 16 (38%) with complex cardiovascular malformations (CVM) or atrial isomerism, 13 (31%) with simple CVM, and 13 (31%) without CVM. Of these, 15 (36%) underwent cardiac surgery, 24 (57%) had an anatomic spleen abnormality, and 7 (17%) had both. The remaining 355 participants were non-SA, including 152 with SIT and 203 with SS. Overall, 70 (17%) participants had the severe CCDC39/CCDC40 genotype. Compared to non-SA participants, those with SA had lower median body mass index Z-scores (p=0.03), lower forced vital capacity Z-scores (p=0.01), more hospitalizations and intravenous antibiotic courses for acute respiratory infections during the 5-years before enrollment (p<0.01). Participants with CVM requiring surgery or anatomic spleen abnormalities had lower median body mass index Z-scores and more hospitalizations and intravenous therapies for respiratory illnesses compared to non-SA participants. InterpretationChildren with PCD and SA have worse nutritional and pulmonary outcomes with more hospitalizations for acute respiratory illnesses than those with SS or SIT combined. Poor nutrition and increased hospitalizations for respiratory infections in SA participants with PCD are associated with CVM requiring cardiac surgery and/or splenic anomalies. ClinicalTrials.gov: NCT02389049, NCT00323167

Abstract 13750: Concomitant Transcatheter Debulking of Right Heart Vegetations During Extraction of Transvenous Device System for Endocarditis: An Eight Case Series

Background: Right heart (RH) infective endocarditis (IE) is a rare but serious complication of transvenous devices (TVD) often requiring system extraction. Surgery is often necessary for large vegetations or when bacteremia persists despite antibiotics. Objective: To evaluate outcomes of patients who underwent transcatheter debulking of IE-related RH vegetations in the setting of a transvenous device endocarditis. Methods: Patients with TVD and IE with RH vegetations were included in this analysis. Half of the patients were debulked using a thrombus aspiration system, while in the other half a hydrodynamic thrombectomy system was used. This was completed via a femoral approach with intracardiac echocardiography guidance. Intra and post-procedural outcomes were recorded. Results: Eight patients with a median age of 58 years, 62.5% male, with TVD, IE, and RH vegetations were included. Vegetations were located on the TV (2), RA lead (4), RV lead (2) and the floor of the RA along the cavotricuspid isthmus (1). The largest vegetation in this series was 5 cm by 2 cm with a volume of 62.83 cm3 and the smallest was 0.4 cm by 0.3 cm with a volume of 0.15 cm3. All patients had substantial vegetation burden causing clinically significant valve dysfunction. The vegetations were successfully debulked in all eight cases. Post-procedure imaging in all eight patients showed at least a 80% reduction in vegetation burden. All patients with TVP leads underwent successful extraction of the pacing systems. All patients tolerated their procedures well and remained free of infection at follow-up after completing a 6-week course of intravenous antibiotics. There were no procedure-related adverse events recorded within 30 days of intervention. Conclusion: TCD is a potential alternative in patients with device infection and large vegetations who are not candidates for surgical intervention. Long-term implications of this intervention in this high-risk population needs further studies.

Diabetes-Driven Dilemma: Tackling The Rise of Melioidosis in India

Melioidosis is a potentially fatal infectious disease that requires an extended period of treatment for complete resolution of the infection. It can lead to chronic and severe infections, and it is more common in diabetic patients. Melioidosis is also a significant concern in India primarily because its chronic nature, potential for dissemination, extended treatment requirements, and the risk of relapse lead to its resemblance to tuberculosis. This case series included osteomyelitis patient presented in emergency with sepsis MODS, disseminated melioidosis patient with systemic involvement including spleen, kidney and lungs, skin abscess at more than one site, urosepsis, splenic abscess, Melioidotic arthritis. Many of these patients had altered blood sugar levels, and in 3 cases, individuals were even diagnosed with diabetes during their episode of melioidosis the treatment duration generally involved an 8-week course of intravenous antibiotics. However, oral medications may need to be continued for several months if necessary for complete recovery.&#x0D;

FRI563 Subacute Thyroiditis Is An Uncommon Cause Of Pyrexia Of Unknown Origin

Abstract Disclosure: N. Luke: None. D. Tay: None. Introduction: Subacute thyroiditis is a rare self-limiting inflammatory thyroid disorder often follows a viral infection. It is a diagnosis that is made clinically when patients present with typical features of anterior neck pain and thyrotoxic symptoms. We share our experience in unraveling a diagnostic challenge of a patient with an atypical presentation of subacute thyroiditis presenting with pyrexia of unknown origin during the Covid 19 pandemic. Clinical case: A 29 years old previously healthy Burmese domestic helper was admitted to a hospital in Singapore for persistent fever of 2 weeks duration associated with persistent sore throat. She had a brief 3 days duration of cough at the onset of fever with no other localizing infective symptoms. She had a booster dose of COVID 19 Moderna vaccination 6 months prior to her presentation with 2 preceding doses of Pfizer-BioNtech vaccine 12 months prior. She was empirically treated for acute pharyngitis with a course of intravenous antibiotics without improvement of her fever. Extensive workup for the fever was performed. A complete blood count showed monocytosis. Blood and urine cultures, urinalysis, COVID polymerase chain reaction (PCR), CMV, EBV, and HIV testing were negative. Respiratory multiplex PCR was negative for adenovirus, coronavirus, influenza, parainfluenza, respiratory syncytial virus, metapneumovirus, rhinovirus, chlamydia, mycoplasma, and Bordetella. CT of the thorax, abdomen, and pelvis was normal. She denied heat intolerance, weight loss, diarrhea, palpitations, or hand tremors. Clinical examination revealed mild anterior neck tenderness but no thyrotoxic features. There were no signs of Graves ophthalmopathy or pre-tibial myxoedema. Thyroid function tests were performed in view of persistent tachycardia which showed elevated free T4 at 51.6 pmol/L (12.7-20.3) with suppressed TSH &amp;lt;0.005 mIU/L (0.3-4.2). TSH receptor stimulating antibody levels (TRab) was elevated at 5.23IU/L (&amp;lt;1.76) and ESR was markedly elevated (115 mm/hr). Thyroid ultrasound showed homogeneous thyroid echotexture with no discrete suspicious nodules or abnormal vascularity. She was started on non-steroidal anti-inflammatory drug (Etoricoxib) with resolution of her fever and neck pain Clinical lesson: Clinicians should be aware that subacute thyroiditis can be a rare cause of pyrexia of unknown origin even in the absence of typical features. Presentation: Friday, June 16, 2023

Short course of intravenous antibiotics in the treatment of uncomplicated proven neonatal bacterial sepsis: A systematic review.

To evaluate the efficacy and harms of a short (7-10 days) compared with a standard (10-14 days) duration of antibiotics in culture-proven neonatal sepsis for reducing all-cause mortality, treatment failure and duration of hospitalisation. Medline, EMBASE and Cochrane CENTRAL were searched for randomised trials. We included five studies, all conducted in India (447 infants with a gestational age greater than 32 weeks). Except for one study, all studies were at high risk of bias. All-cause mortality was reported in three studies with only one death reported in the standard duration regimen arm (243 patients, very low certainty). A meta-analysis showed no evidence of the effect on treatment failure (RR of 1.47 [95% CI 0.48-4.50], 440 patients, five studies, very low certainty) of short-term antibiotics. Short-term antibiotic regimen shortened the duration of hospitalisation by 4 days (mean difference of -4.04 days [95% CI -5.47 to -2.61]; 4 studies; 371 patients; very low certainty). Among studies focused on infants born with a gestational age greater than 32 weeks, short-term administration of antibiotics may shorten the duration of hospitalisation, but the evidence is very uncertain. The evidence on other predefined outcomes is very uncertain to draw definite conclusions.

Dynamic Hyperinflation While Exercising-A Potential Predictor of Pulmonary Deterioration in Cystic Fibrosis.

Lung function deterioration in cystic fibrosis (CF) is typically measured by a decline in the forced expiratory volume in one second (FEV1%), which is thought to be a late marker of lung disease. Dynamic hyperinflation (DH) is seen in obstructive lung diseases while exercising. Our aim was to assess whether DH could predict pulmonary deterioration in CF; a secondary measure was the peak VO2. A retrospective study was conducted of people with CF who performed cardiopulmonary exercise tests (CPETs) during 2012-2018. The tests were classified as those demonstrating DH non-DH. Demographic, genetic, and clinical data until 12.2022 were extracted from patient charts. A total of 33 patients aged 10-61 years performed 41 valid CPETs with valid DH measurements; sixteen (39%) demonstrated DH. At the time of the CPETs, there was no difference in the FEV1% measurements between the DH and non-DH groups (median 83.5% vs. 87.6%, respectively; p = 0.174). The FEV1% trend over 4 years showed a decline in the DH group compared to the non-DH group (p = 0.009). A correlation was found between DH and the lung clearance index (LCI), as well as the FEV1% (r = 0.36 and p = 0.019 and r = -0.55 and p = 0.004, respectively). Intravenous (IV) antibiotic courses during the 4 years after the CPETs were significantly more frequent in the DH group (p = 0.046). The peak VO2 also correlated with the FEV1% and LCI (r = 0.36 and p = 0.02 and r = -0.46 and p = 0.014, respectively) as well as with the IV antibiotic courses (r = -0.46 and p = 0.014). In our cohort, the DH and peak VO2 were both associated with lung function deterioration and more frequent pulmonary exacerbations. DH may serve as a marker to predict pulmonary deterioration in people with CF.

Intravenous antibiotic therapy after laparoscopic appendectomy in acute complicated appendicitis: the patient clinical response is the key.

The guidelines about acute complicated appendicitis (ACA) recommend 3-5 days of postoperative intravenous antibiotics (IVA). Nevertheless, the time selected by the surgeon can vary according to patient clinical response, ACA type, and professional experience. Once an adequate clinical response is obtained, the change from IVA to oral antibiotic (OA) could be realized without the waiting time established with satisfactory results. Determine if a short course of IVA and/or switch to oral route is safe based on the patient clinical response. Observational prospective cohort study from a general surgery reference center database since July 2019. 48 patients with ACA intraoperative findings were included. Regarding postoperative antibiotic management, only preoperative IVA: 7 (14.58%), IVA 1-3 days: 1 (20.83%), IVA 1-3 days and change to OA: 21 (43.75%), IVA > 3 days: 6 (12.5%), and only OA: 3 (27.08%). The bivariate analysis did not show statistically significant differences in reconsultation (p = 0.81), rehospitalization (p = 0.44), and surgical site infection (p = 0.56) between the antibiotic scheme based on the postoperative clinical response and the traditional one regarding intra-abdominal collection rate, the hospital stays, and hospitalization costs.

1299 Puerperal Shoulder Pain: A Rare Case of Glenohumeral Joint Septic Arthritis

Abstract Introduction Native glenohumeral joint septic arthritis is a rare manifestation of an occult bacteraemia. Without urgent diagnosis and intervention, septic arthritis can lead to rapid cartilaginous and joint destruction. We report an unusual presentation of postpartum streptococcal glenohumeral arthritis. Case Description A fit and healthy 34-year-old woman gravida 2 para 3 developed unremitting shoulder pain, reduced range of movement and tachycardia day 1 postpartum after a vaginal delivery associated with a grade two perineal tear. Initial blood work revealed rising inflammatory markers, CRP 275, WCC 16.2. Initial radiographs showed no significant abnormality. T2 weighted MRI revealed a large glenohumeral joint effusion. All samples from joint aspirate grew Group B streptococcus (GBS), concordant with a high vaginal swab taken in the late third trimester. The patient underwent urgent arthroscopic washout and synovial sampling, growing GBS. Transthoracic echocardiogram revealed no imaging evidence of infective endocarditis. The patient was commenced on an appropriate 6-week intravenous antibiotic course and clinically improved. Physiotherapy and rehabilitation improved shoulder range of movements. Discussion There is a scarcity of orthopaedic complications reported with obstetric pathology. Atraumatic joint pain associated with physiological, or biochemical signs of infection should alert the diagnosing surgeon to consider septic arthritis. Haematogenous bacterial translocation can cause atypical presentations of septic arthritis. Routine biochemical parameters and arthrocentesis continues to prove to be the gold standard of diagnosis. A compilation of a case series detailing location, microorganism, complications, and effective treatment would prove useful to tailor management of these rare presentations.

Group B Streptococcus infection-induced ovarian vein thrombosis identified during cesarean section: A case report and a literature review.

Ovarian vein thrombosis (OVT) is a rare yet potentially life-threatening condition associated with thromboembolic events. Group B Streptococcus (GBS) is a type of β-hemolytic Gram-positive bacterium known for asymptomatic colonization in the lower genital and gastrointestinal tracts. Here we reported a 35-year-old multiparous woman with gestational diabetes who suffered from placental abruption, stillbirth, OVT, septic shock, and renal failure due to severe GBS infection. A 35-year-old woman with gestational diabetes presented with acute and sustained lower abdominal cramping, vaginal bleeding, and fever at 35 gestational weeks. Based on preoperative ultrasound and intraoperative findings, the patient was diagnosed with placental abruption, intrauterine fetal demise, and right OVT. GBS was cultured from the amniotic fluid obtained during cesarean section. The patient underwent a right adnexectomy during a cesarean section and received intravenous antibiotics. Subsequently, an ultrasound-guided uterine curettage was performed due to recurrent fever. After a prolonged course of intravenous antibiotics for over a month, the patient recovered and was discharged from the hospital. This case underscores the need for early initiation of anticoagulant protocols in cases of OVT, particularly when GBS infection is identified as a predisposing factor. Further research and awareness are warranted to better understand the relationship between GBS infection and OVT and to optimize management strategies in such cases.

ID: 218987 Utilization of Neuromodulation for Failed Back Surgery Syndrome in Setting of Recurrent Infections

A 70-year-old female with a past medical history significant for recurrent skin infections, fibromyalgia, Ehlers Danlos Syndrome, and chronic back pain secondary to T12 compression fracture, multilevel spondylosis, and stenosis s/p L2-S1 laminectomy/fusion presented to the ED for significant worsening of her chronic back pain. One-week prior, patient was seen by her primary care physician for a left forearm abscess, underwent incision and drainage in the office, and was discharged on oral antibiotics. One month later, patient began experiencing intractable back pain with associated bilateral lower extremity weakness and subsequently went to the ED. Manual muscle testing of her lower extremities was 3/5 throughout, with no other red flag signs or symptoms. A thoraco-lumbar MRI revealed a T9-T10 epidural collection suggestive of an epidural abscess with cord compression, in addition to a chronic T12 compression fracture. She underwent a T9-T10 laminectomy, with her post-operative course being uneventful. She was discharged to subacute rehab to complete a course of intravenous antibiotics. She was told to follow up for kyphoplasty after her infection clears. One month post-operatively patient continued to have radicular symptoms bilaterally and continued back pain and returned to the ED. An MRI of her thoraco-lumbar spine revealed worsening of T12 compression fracture, T10-T11 vertebral disc herniation with adjacent enhancing fluid collection in the right ventral epidural space suspicious for abscess vs extruded disc material.

The centripetal endoscopic sinus surgery in patients with cystic fibrosis: A preliminary study

ObjectivesThe main aim of this study is to analyze the possible differences between clinical, demographic or genetic characteristics, in Cystic Fibrosis (CF) patients with chronic rhinosinusitis (CRS) with different phenotype. The secondary objective is to describe the possible benefit of surgery with Centripetal Endoscopic Sinus Surgery (CESS). MethodsThe study includes 56 who performed CT scan of the paranasal sinuses. They were divided in 3 group according to phenotype: CRS without Nasal Polyps (NP); CRS with NP; CRS complicated with Mucocele. The clinical symptoms, age, gender, genotype, microbial colonization and pulmonary disease stage were collected and analyzed to assess possible statistically significant differences. Regarding the 7 patients who performed CESS surgery, the number of hospitalizations, intravenous (iv) antibiotic courses, respiratory exacerbations, the FEV1, the Lund-Mackay Score (LMS) and the SNOT 22 were evaluated before and 1 year after surgery. ResultsNo statistically significant differences regarding clinical symptoms between the 3 groups were identified (p > 0.05). Furthermore, there were no differences in age, gender, genotype, microbial colonization and pulmonary disease stage (p > 0.05). Regarding the patients who performed CESS, no significative difference in FEV1 progression was found. A reduction in hospitalization, pulmonary exacerbation and in the number of iv antibiotic courses resulted statistically significant different (p = 0.004; <0.001 and <0.001 respectively). A significant improvement in SNOT-22 and LMS (p < 0.001) was obtained. ConclusionRadiological monitoring of the rhinosinus disease is necessary regardless of the clinical expression of the disease. The presence of CRS with NP complicated by mucocele is frequent and independent of the patient's age and clinical manifestations. An extensive surgical approach could represent the gold standard for patients with CF in consideration of the potential important advantages to perform a total toilet of all the sinuses and nasal cavities and at the same time eliminating a potential microbiological reservoir.