Long-term Systemic Antibiotic Therapy Research Articles

CONTROVERSIAL ISSUES OF ANTIBIOTIC THERAPY DURATION IN PATIENTS AFTER INJURIES AND SURGERIES ON MUSCULOSKELETAL SYSTEM

Improvements in surgical techniques and the introduction of minimally invasive osteosynthesis technologies have had a beneficial effect on the patient treatment after injuries and surgeries on the musculoskeletal system. However, the problem of treating infectious complications, especially in elderly patients with high comorbidity, has not lost its relevance.
 The purpose of the paper is to study the effectiveness of antibiotic therapy in elderly patients after injuries and surgeries on the musculoskeletal system in comorbidity.
 Materials and methods. An open prospective cohort study was conducted with a 12-month follow-up period. We examined 53 elderly and senile patients (24 men and 29 women, average age 69.1±7.3) who were hospitalized. The combined endpoint of treatment outcome was assessed. Comorbidity and duration of antibiotic therapy were determined in all patients. The GerontoNet ADR Risk Score was used to assess the risk of drug therapy complications.
 Results. The comorbidity index in elderly patients was 4 (3; 5) points. One third of patients (19 people; 35.9 %) had high comorbidity rates. The average number of antibacterial drugs was 2 (1; 2). Total course of administration was 8 (5; 21) days. Therapy duration less than 7 days was observed in 24 (45.3 %) patients. In 13 (24.5 %) patients, the result exceeded 5 points on the GerontoNet scale. During the observation period, a positive result was achieved in 45 (84.9 %) patients. There was no significant difference in achieving positive results based on the duration of antibiotic therapy (p>0.05).
 Conclusion. The use of long-term systemic antibiotic therapy in elderly patients after injuries and surgeries on the musculoskeletal system does not lead to better results compared to shorter treatment modalities, which help us avoid unwanted side effects and drug interactions, given the high comorbidity of this group of patients.

Successful addition of topical antibiotic treatment after surgery in treatment-refractory nontuberculous mycobacterial skin and soft tissue infections.

Treatment of skin and soft tissue infections with nontuberculous mycobacteria sometimes fails despite repeated debridements and long-term systemic antibiotic therapy. These treatment-refractory infections can cause significant morbidity and pose a treatment challenge. Following surgery, we treated three patients with negative pressure wound therapy with the instillation and dwell time of topical antibiotics, in addition to systemic antibiotic treatment. Treatment was successful and well tolerated, except for some local irritation.

Long-term systemic antibiotics and surgical treatment can be an effective treatment option for retrobulbar abscesses in rabbits (Oryctolagus cuniculus): 21 cases (2011-2022).

To characterize the epidemiologic features of rabbits with retrobulbar abscesses, including the clinical signs, diagnosis, treatment, and outcome. 21 client-owned rabbits. The medical record database of a veterinary teaching hospital was searched from 2011 to 2022 for records of rabbits diagnosed with retrobulbar abscesses by CT. Data reviewed included age, breed, presenting complaint, association with an odontogenic infection, aerobic and anaerobic culture results, treatment, and outcome. The primary presenting complaint was exophthalmos (19/21 [90%]). Most cases (15/21 [71%]) were associated with an odontogenic infection. Dental disease, not associated with a retrobulbar abscess (14/21 [67%]), was a common comorbidity on CT. The most common aerobic and anaerobic isolates were Streptococcus intermedius (5/12 [42%]) and Fusobacterium nucleatum (2/12 [17%]), respectively. Surgical treatment combined with long-term systemic antibiotic therapy was performed in 9 of 21 (43%) cases. It included intraoral tooth extraction (4/9 [44%]) versus extraoral peribulbar abscess lancing with either abscess packing with antibiotic-soaked gauze (3/9 [33%]) or surgical abscess debridement (2/9 [22%]). Resolution of the clinical signs with no recurrence for at least 6 months occurred in 7 of 9 (78%) surgically treated cases. Medical treatment with long-term systemic antibiotic therapy was performed in 4 of 21 (19%) cases, and 3 of 4 (75%) resolved. Due to poor prognosis or financial concerns, euthanasia was performed or recommended in 8 of 21 (38%) cases. On the basis of the data from this study, retrobulbar abscesses in rabbits carry a guarded prognosis. When intraoral and extraoral surgical treatment options combined with systemic antibiotic therapy were used, it resolved clinical disease in most cases.

Healer Granules in Nonhealing Infected Wounds.

Background:Head-and-neck infection is one of the most frequently encountered issues in the field of oral and maxillofacial surgery. Most of the cases with head-and-neck infections are managed by empirical antibiotic therapy and extraction of offending infected tooth/teeth. However, long-term systemic antibiotic therapy can have profound compromising effects on host immune defense and thereby hamper healing, which, in turn, may lead to life-threatening complications such as localized septic foci or widespread septicemia at times leading to death of an individual. In this study, we are reviewing management of 15 cases with space infection in the maxillofacial region by local drug delivery with the help of collagen particles combined with mupirocin 2% w/w and metronidazole 1% w/w (BioFil-AB). We intend to study its efficacy in managing the space infections associated with extraoral infected wound as well as in preventing hazards of long-term systemic antibiotic therapy.Aims:The aim of this study is to assess the efficacy of the topical use of BioFil-AB in infected maxillofacial wounds.Materials and Methods:A total of 15 patients with infected maxillofacial wounds reporting to the department of oral and maxillofacial surgery were categorized into three groups depending on the severity of infections. Of these 15 cases, 8 patients were suffering from infected extraoral wounds, 3 had traumatic infection, and remaining 4 had extraoral consolidated abscesses due to odontogenic infection. All patients had a history of prior antibiotic therapy. Incision and drainage of the septic focus/foci were performed in most of the cases, and healing of the site was assessed after application of topical BioFil-AB (mupirocin + metronidazole + collagen granules) dressing.Results and Conclusion:Dressing with BioFil-AB granules proved to be efficient in control of infection as well as in promoting uneventful wound healing, especially with good follow-up. Further studies with a large sample size may be necessary to corroborate the findings and provide substantial evidence. This novel local drug delivery therapy will definitely help in maintenance of good host immune response as well as in preventing or minimizing occurrence of antibiotic resistance.

BANEOTSIN® (POWDER, OINTMENT) – PERSPECTIVE FOR USE IN COMPLEX SURGICAL TREATMENT OF PURULONECROTIC DISEASES OF THE LOWER EXTREMITIES IN PATIENTS WITH DIABETIC FOOT SYNDROME

Objective – to improve the results of the topical medical treatment of wounds in patients with various forms of diabetic foot syndrome (DFS). Materials and methods. A comparative in vitro study of the antimicrobial and osmotic activity of Baneotsin® and ointments on the basis of polyethylene glycol was done. The subject of the clinical study were 18 patients with DFS. Out of these patients 8 (44.4 %) had the neuro-ischemic form and 10 (55.6 %) had the neuropathic form. According to depth and prevalence of purulonecrotic process, in 3 (16.7 %) cases there was indicated Stage II of the process according to Wagner, in 9 (50.0 %) cases – Stage III and in 6 (33.3 %) patients – Stage IV. All patients had type 2 diabetes of severe treatment, on insulin. Average age of the patients was 61.3 ± 1.4 years. The average rate of glycated hemoglobin of patients on ad- mission to hospital was 8.4 ± 1.3 %. After radical surgical treatment of purulent foci with careful removal of all necrotic tissue all patients had surgical wounds treated with 0.2 % solution of Lavasept®. 3 (16.7 %) patients with the ulcer surface without obvious signs of perifocal inflammation had bandage with Baneotsin® powder after treatment, and after 4–5 days after detecting signs of wound process during the transition to phase II the treatment was continued under the bandage with ointment Baneotsin®. In 10 (55.6 %) cases (in the results of microbiological tests were found aerobic and obligate anaerobes) the treatment of postoperative wound was done under the bandages with 5 % Dioxydine ointment for 2–3 days. 5 (27.8 %) patients (without clinical and bacteriological data of obligate anaerobes) were treated with ointment of Levomekol immediately after the operation. After 7–10 days, the patients were discharged to the outpatient treatment phase with recommendations to continue treatment with bandages with Baneotsin® powder (for 4–5 days) and then with ointment Baneotsin®. Systemic antibiotic therapy at the hospital stage of treatment lasting more than 7 days, was used only in 4 (22.2 %) cases. Results. In patients with trophic anabrosis (3 (16.7 %) persons) it was managed to heal the defects by secondary intention in the period of up to 1 month after surgical treatment. The other wounds were prepared to run the final stage of treatment – the plastic reconstruction of the foot in the period from 10–14 days to 1 month. High ablations and fatal cases in the researched group of patients were not recorded. Conclusion. Application of the algorithm of topical drug treatment of wounds with Baneotsin® powder and ointment, polyethylene glycol based ointments having different osmotic activity, depending on the severity and extent of purulent process in soft tissues, lets to avoid the prescription of long-term systemic antibiotic therapy and to accelerate the transition of purulonecrotic wounds in the phase II of wound process.

Antiseptics and antibiotics on implants

Incidences of infection following elective orthopedic surgery are low and range from 0.7−4.2%, depending on the type of operation, soft-tissue status, general patient condition, and prophylactic use of antibiotics. Patients with open fractures clearly show a higher risk of infection (5−33%) due to bacterial contamination and soft tissue damage. The consequences of such infections can be devastating, leading to prolonged hospitalization, poor functional outcome, and sepsis. Bone infections associated with foreign bodies such as prostheses or osteosynthetic devices are especially difficult to treat. Procedures frequently required include removal of the infected device, long-term systemic antibiotic therapy with possible side effects, and multiple revisions with radical debridement. Systemically administered antibiotics are necessary and effective in therapy in addition to surgical revision. A serious problem is the increasing number of implants infected by (methicillinresistant Staphyloccus aureus) MRSA and chronic Staphyloccus epidermidis. Due to disturbed tissue function caused by surgical trauma at the implant/tissue interface, bacteria seeded during surgery may cause later infection. Mainly S. epidermidis, but also certain strains of S. aureus, tend to produce an extracellular polysaccharide matrix (biofilm) if they attach to foreign body surfaces. Biofilm formation makes eradication of these microorganisms nearly impossible without removing the implant. S. aureus and coagulase negative staphylococci (S. epidermidis) can be isolated from deep wound infections in up to 70−90% of cases. Systemic perioperative application of antibiotics is routinely performed in orthopedic and trauma surgery, the efficacy of which has clearly been proven. High levels of tissue protection are achieved during surgery to prevent deep wound infection caused possibly by contaminating bacteria. In addition to systemic prophylaxis, various local antibiotic delivery techniques are in clinical use to reduce the rate of infection (antibiotic-loaded bone cements, antibiotic-impregnated collagen sponges or polymethylmethacrylate beads). Local application of antibiotics is advantageous in that high levels can be achieved around the implant without systemic toxicity. However, low drug levels provided over a long period could be disadvantageous and might cause the development of drugresistant bacterial strains. In several in vitro and in vivo studies and first clinical cases, it has been proven that locally delivered gentamicin from a biodegradable poly (D, L-lactide) (PDLLA) coating of implants with an initial burst release at high concentration could be an effective supplement for prophylaxis of implant-related infection in orthopedic and trauma surgery. This new approach in addition to established systemic antibiotic prophylaxis could reduce the infection rate especially in open-fracture situations. Antiseptics and antibiotics on implants

Ruptured Abdominal Aortic Aneurysms due to Salmonella, not of typhi Species

Ruptured aortic aneurysms due to Salmonella not of typhi species are rare and associated with high morbidity and mortality. We present three patients with Salmonella-infected ruptured aortic aneurysms successfully treated with an in situ prosthetic bypass graft. One patient had a saccular aneurysm at the infrarenal aorta and two patients had fusiform aneurysms at the aortic bifurcation. All the patients were treated with wide debridement of the infected aortic tissue followed by in situ graft replacement and long-term systemic antibiotic therapy. The method of revascularization, in situ bypass or extraanatomic bypass, remains controversial. On the basis of our clinical experience and recent literature focusing on more than 10 cases, in situ bypass reconstruction may be a feasible surgical technique for Salmonella-infected ruptured aortic aneurysm.

The Bacteriology of Acne Vulgaris and Antimicrobial Susceptibility of Propionibacterium acnes and Staphylococcus epidermidis Isolated from Acne Lesions

We examined the species of bacteria aerobically and anaerobically isolated from 30 acne lesions and determined antimicrobial susceptibilities of Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) using nine antimicrobial agents. Among the bacteria isolated, S. epidermidis was most dominant. Both P. acnes and S. epidermidis were isolated from half of the acne lesions. The MIC of seven antimicrobials (ampicillin, erythromycin, roxithromycin, clindamycin, tetracycline, minocycline, nadifloxacin) against P. acnes was under 3.13 micrograms/ml. There were very few resistant strains of P. acnes, but many of S. epidermidis. More than 30% of the S. epidermidis isolates were resistant to erythromycin, roxithromycin, and clindamycin. After long-term systemic antibiotic therapy, the resistant strains of S. epidermidis increased, but P. acnes resistance was still limited. When we use antimicrobial agents for the treatment of acne, it should be noticed that not only P. acnes but also S. epidermidis in the acne lesions may acquire resistance to antimicrobials.

Periocular atypical mycobacterial infections

Objective To examine the clinical characteristics and management of periocular infections caused by atypical mycobacteria. Design Retrospective, noncomparative case series. Participants Six patients were identified with periocular atypical mycobacterial infections: four with Mycobacterium chelonae and two with Mycobacterium fortuitum. Intervention The treatment of these infections included removal of the foreign bodies with debridement of the lesions. Specimens were sent for histopathologic examination, routine cultures, and fresh tissue for culture after homogenization. Main outcome measures A retrospective review of culture-proven atypical mycobacterial infections involving the periocular tissues was performed. Charts were reviewed for age, gender, infectious organism, medical history, surgical history, presenting symptoms, clinical features, and treatment. Results Four associations with infection were identified in these patients: immunosuppression, nasolacrimal duct obstruction, the presence of a foreign body, and a history of recent surgery. All six of the patients had at least one of these associations and five of the patients had at least two. Clinical characteristics that may distinguish atypical mycobacterial infections from acute bacterial infections include subacute presentation, firm nodular lesions, mild erythema, mild tenderness, and minimal purulent discharge. All patients had resolution of their infections after debridement and several weeks of systemic antibiotic therapy guided by susceptibility testing. Conclusions Periocular atypical mycobacterial infections are uncommon. The clinical history and examination can raise the suspicion of this infection by revealing the clinical characteristics of these infections. Treatment includes removal of foreign bodies, debridement, and long-term systemic antibiotic therapy.

Long-term antibiotic therapy for balanitis xerotica obliterans

In an open uncontrolled study of 3 patients with balanitis xerotica obliterans we have observed significant improvement after long-term systemic antibiotic therapy. Two of the patients noticed softening of the skin as well as disappearance of pruritus, tenderness, and inflammatory changes within 3 weeks of receiving oral and intramuscular penicillin. The third patient experienced the same degree of improvement after a regimen of dirithromycin, 500 mg/day. Stopping the antiobiotic for 1 month resulted in relapse, with improvement again on resumption. (J Am Acad Dermatol 1999;40:69-72.)

Cryptogenic Salmonella-infected ruptured aortic aneurysms

Salmonella-infected ruptured aortic aneurysms are a difficult surgical problem. Five patients with Salmonella-infected ruptured aortic aneurysms are presented. All patients were initially treated by in situ graft replacement, wide debridement of the infected aortic tissue and long-term systemic antibiotic therapy. The surgical technique of choice in acute situations, such as a rupture of the aneurysm, remains controversial. In the recent literature 26 reported cases were reviewed. Based on our clinical experience and these case reports, in situ bypass reconstruction can be justified as a surgical technique that gives at least a good short-term prognosis.