Months Of Antibiotics Research Articles

Primary total elbow arthroplasty in complex fractures of the distal humerus.

To evaluate short- to medium term outcome of total elbow arthroplasty (TEA) in complex fractures of the distal humerus. A consecutive series of 24 complex distal humerus fractures operated with TEA in the period 2006-2012 was evaluated with the Mayo Elbow Performance score (MEPS), plain radiographs, complications and overall satisfaction. The indications for surgery were 1: AO type B3 or C3 or Sheffield type 3 fracture and age above 65 or 2: fracture and severe rheumatoid arthritis. Mean follow-up time was 21 mo. Twenty patients were followed up. Four patients, of which 3 had died, were lost to follow up. According to the AO classification there were 17 C3, 1 B2 and 2 A2 fractures. Mean follow-up was 21 months (range 4-54). Mean MEPS was 94 (range 65-100). Mean flexion was 114 degrees (range 80-140). According to MEPS there were 15 excellent, 4 good and 1 fair result. Patient satisfaction: 8 excellent, 10 good, 2 fair and 1 poor. There were two revisions due to infection treated successfully with revision and three months of antibiotics. In two patients the locking split had loosened. One was referred to re-insertion and one chose yearly controls. Two patients had persistent dysaesthesia of their 5th finger, but were able to discriminate between sharp and blunt. Our study suggests that TEA in complex fractures of the distal humerus in elderly patients can result in acceptable short- to medium term outcome.

Persistent Rhodococcus equi infection in a renal transplant patient: case report and review of the literature

Rhodococcus equi is a pathogen that mainly causes infection in immunocompromised hosts. We report a case of relapsing R. equi pulmonary infection in a 57-year-old male renal transplant recipient who was treated with 12months of antibiotics, adjunctive surgery, and a reduction in his immunosuppression. He suffered from relapsing disease, treatment-related complications, and ultimately died of Pneumocystis pneumonia. Case reports in the literature portray a good cure rate for transplant-related R. equi infections, with shorter durations of antibiotics. The case illustrates the difficulties in the management of R. equi infections. Forty cases from the literature were reviewed and compared in terms of epidemiology, location of infection, transplant type, immunosuppression used, treatment used, outcomes, and possible exposures.

Cervical Epidural and Retropharyngeal Abscess Induced by a Chicken Bone

Retropharyngeal abscess is occasionally seen in children, but is less common in adults where it usually occurs secondary to iatrogenic oropharynx trauma or a perforated foreign body in the oropharynx. Spinal epidural abscess in combination with a retropharyngeal abscess, which may cause rapid and irreversible neurological deterioration, is not often found, as indicated by the very few reports in the literature. Here we report a 52-year-old male with a clinical history of seizure and mental retardation since childhood who presented at our emergency room with severe sore throat of 1 day’s duration. A chicken bone was removed successfully. However, he complained of progressive dysphagia, sore throat and posterior neck pain during the following 5 days. Flexible fiber-laryngoscopy showed bulging of the retropharyngeal wall and a small ulcer at the right posterior pharyngeal wall. A neck computed tomography (CT) scan showed a retropharyngeal abscess at the oropharynx and hypopharynx level. His symptoms showed partial improvement after the administration of intravenous antibiotics. However, 2 weeks later he developed high fever, posterior neck pain and flaccid tetra-paresia. Emergent neck CT scan revealed a mild retropharyngeal abscess and epidural abscess formation between the second and third cervical vertebrae. The patient’s family refused drainage of the pre-vertebral and epidural pus. After receiving 2 months of antibiotics, the patient regained the mobility of his limbs

MYCOBACTERIUM CHELONAE HAND INFECTION: A REVIEW

Six cases of culture-proven Mycobacterium chelonae tenosynovitis were identified through retrospective chart review. Fifteen cases were identified using computerised Medline search. Clinical features, treatment and outcome were described. Infection control was achieved in our patients with an average of 3.2 surgeries each and antibiotic treatment for six months to one year. Eleven published cases were managed by combined surgery and systemic antibiotics, with an average of 1.73 surgeries per patient and seven weeks to 24 months of antibiotics. All our patients were disease free on final follow-up. Thirteen cases were resolved. Functional outcomes were reported for eight cases. Comparison of functional outcome was not possible because different parameters were used in different reports. Aggressive debridement, susceptibility-guided antibiotics, and supervised rehabilitation resulted in infection control and acceptable hand function for our patients. Standardised data collection on subsequent cases would facilitate outcome monitoring and formulation of a treatment guideline for this disease.

First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome

We report the 1st case of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis after acupuncture, with articular cartilage destruction and chronic osteomyelitis. The patient responded to arthrotomy, synovectomy, and 6 months of antibiotics. The emergence of community-associated MRSA infections would further aggravate the problem. Strict adherence to proper infection control guidelines is mandatory.

L’ostéomyélite hématogène du calcanéum chez l’enfant : à propos de 26 cas

Osteomyelitis is rarely observed in the calcaneus; about 3 to 10% of the bone infections in children. The diagnosis is often established late because of the less pronounced symptoms in long-bone localizations. We report a series of 26 cases of osteomyelitis of the calcaneus observed in children. We studied the clinical history, the diagnostic process and the treatments delivered. Outcomes were assessed in terms of complications, anatomy and function at mean two years follow-up (range one to seven years). There were 15 boys and 11 girls, mean age was seven years (range one month to 13 years). Mean time from symptom onset to consultation was 13 days and mean time from consultation to hospital admission was four days, range one to 29 days. The clinical presentation was not specific. Body temperature was not above 38.5 degrees C in 45% of patients. Symptoms were fever, pain in the rear foot and functional impotency of the lower limb. Eight patients (30%) complained of moderate pain, 18 (70%) of intense pain. The pain was focused far from the calcaneus in six patients, retarding the diagnosis. Laboratory tests did not always reveal signs of inflammation. White cell counts above 10,000 were noted in only 61% of patients. The diagnosis of osteomyelitis of the calcaneus was based on: the plain X-ray, which revealed a defect in the calcaneus (n=12), ultrasound (performed in 19 patients) which revealed calcaneal subperiosteal detachment (n=6), collections in the rear foot (n=3) and soft-tissue thickening (n=4). Bone scintigraphy was performed in one child and showed intense uptake in the calcaneus. Magnetic resonance imaging, performed in one patient, demonstrated an anomalous signal in the calcaneus (high-intensity T(2) and low-intensity T(1) with presence of a subperiosteal abscess). Bacteriology was positive in 53% of the children. Medical treatment was delivered for all patients and 23 underwent a surgical procedure. For one of the three patients treated medically, the diagnosis of osteomyelitis of the calcaneus was clinical, since the plain X-ray was normal, the ultrasound yielded no evidence of abscess formation and the bacteriology was negative; but after two months of antibiotic treatment, bone remodelling was in favour of osteomyelitis of the calcaneus. For the two other patients treated medically, the plain X-ray showed a defect in the calcaneus, which had filled after two months of antibiotics. For the 23 patients treated surgically, the procedure was an evacuation of a subperiosteal abscess for 13 (n=6 nonruptured and 7 ruptured). Surgery revealed a bone lesion in nine children allowing curettage of the defect. Articular involvement was noted in eight cases: subtalar osteoarthritis (n=6) and tibiotarsal arthritis (n=2). Two surgical explorations failed to find any abscess formation; blood cultures confirmed the diagnosis and enabled isolation of the causal germ. Outcome was assessed with a mean follow-up of two years, range one to seven years. Nineteen patients (73%) were free of sequelae. Seven patients (27%) presented poor outcome with significant limitation of motion in the rear foot and ankle ankylosis. Seven patients developed chronic fistules, with persistent discharge at last follow-up. The poor results were observed in patients treated late with mean 17 days before consultation. Six of the seven cases of poor outcome were associated with arthritis involving a calcaneal joint (subtalar and tibiotarsal in two patients and subtalar in four). The same pathophysiological phenomenon as observed in long-bone localizations is noted for osteomyelitis of the calcaneus; the calcaneus has an apophysis, which is equivalent to the metaphyseal region of long bones, leading to the bone's vulnerability to hematogenous infection. Late diagnosis can be related to the notion of trauma, the manifestations of osteomyelitis being attributed to ligament injury. The positive diagnosis of osteomyelitis of the calcaneus is often established late because of late consultation (13 days in our series) or the minimal expression of general signs. Magnetic resonance imaging contributes significantly to diagnosis by showing an abnormal bone signal; it can also disclose associated abscess formation. Authors differ in their descriptions of the complications. The analysis of our results shows that the prognosis of osteomyelitis of the calcaneus is related to early diagnosis and management. Associated septic arthritis is an element of poor prognosis.

Mycoplasma and ureaplasma colonisation in women with lower urinary tract symptoms

SummaryTo assess the prevalence of mycoplasma and ureaplasma (MH/UU) in women with bladder symptoms with or without sterile pyuria and to assess the effect of long-term (3 months) antibiotics on symptom improvement in women with significant pyuria and positive culture for MH/UU, urine reports on midstream samples of urine sent from urogynaecology department of one tertiary referral centre over 1 year were studied. Notes for sterile pyuria with positive culture for atypical organisms were retrieved and the data were entered onto Microsoft Excel and analysed. A total of 1,032 urine specimens were analysed between January and December 2005. Out of these, 319 were studies for atypical organisms (31%) and 31 of these were samples repeated on the same patients. The total positive culture rate was 33.7% (97/288). The prevalence of ureaplasma only was 26% (75) and combined mycoplasma and ureaplasma was 7.6% (22) in the first test samples. Of the 97 samples that were positive for atypical organisms, 34% (33) were also positive for typical organisms. Out of the 14 case notes studied, 10 women reported improvement of symptoms (71.4%) with 3 months of antibiotics and 2/9 who had repeat culture were positive for ureaplasma in spite of improvement in symptoms. There was no correlation found for co-existence of typical and atypical UTI or for sterile pyuria and mycoplasma/ureaplasma colonisation. There is a trend towards improvement of symptoms following long-term (3 months) antibiotics in women who have positive culture of MH/UU. A larger prospective randomised controlled trial is necessary to assess the effectiveness of this intervention.

Staphylococcus aureusSmall Colony Variants in Prosthetic Joint Infection

Small colony variants of Staphylococcus aureus tend to persist despite antimicrobial therapy, especially when involved in implant-associated infections. We analyzed 5 cases of hip prosthesis-associated infections due to small colony variants, including their course prior to identification of the pathogen. Biopsy investigations included microbiological examination and, in 1 case, transmission electron microscopy to detect intracellular bacteria in nonprofessional phagocytes. A treatment concept was elaborated on the basis of a published algorithm and patients were managed accordingly. The patients' mean age was 62.2 years. All patients experienced treatment failures prior to isolation of small colony variants, despite as many as 3 surgical revisions and up to 22 months of antibiotics. Transmission electron microscopy performed on biopsy specimens from periprosthetic tissue revealed intracellular cocci in fibroblasts. All prostheses were removed without implanting a spacer, and antimicrobial agents were administered for 5.5-7 weeks. Reimplantation of the prosthesis was performed for 4 patients. Follow-ups were uneventful in all 5 cases. In the case of a poor response to adequate antimicrobial and surgical treatment in implant-associated staphylococcal infections, small colony variants should be considered and actively sought. In our case series, a 2-stage exchange without implantation of a spacer combined with antimicrobial therapy for an implant-free interval of 6-8 weeks was associated with successful outcome, with a mean follow-up of 24 months.

Transient monoclonal gammopathy in a patient withBartonella quintana endocarditis

Monoclonal gammopathy has been reported rarely in association with infectious diseases. Viral infection has been the most frequently reported. We report a case of Bartonella quintana endocarditis in a 45-year-old homeless male associated with a monoclonal IgG kappa gammopathy. The gammopathy disappeared after 8 months of antibiotics while the Bartonella antibody titre was decreasing. This correlation suggests a causative role for B. quintana for the monoclonal gammopathy. To the best of our knowledge, this the first report of monoclonal gammopathy in the course of B. quintana infection.

The salt of tears

<h3>Objective</h3> Recent evidence suggests that antibiotic use, which alters the gut microbiome, is associated with an increased risk of colorectal cancer. However, the association between antibiotic use and risk of colorectal adenoma, the precursor for the majority of colorectal cancers, has not been investigated. <h3>Design</h3> We prospectively evaluated the association between antibiotic use at age 20–39 and 40–59 (assessed in 2004) and recent antibiotic use (assessed in 2008) with risk of subsequent colorectal adenoma among 16 642 women aged ≥60 enrolled in the Nurses9 Health Study who underwent at least one colonoscopy through 2010. We used multivariate logistic regression to calculate ORs and 95% CIs. <h3>Results</h3> We documented 1195 cases of adenoma. Increasing duration of antibiotic use at age 20–39 (p_trend=0.002) and 40–59 (p_trend=0.001) was significantly associated with an increased risk of colorectal adenoma. Compared with non-users, women who used antibiotics for ≥2 months between age 20 and 39 had a multivariable OR of 1.36 (95% CI 1.03 to 1.79). Women who used ≥2 months of antibiotics between age 40 and 59 had a multivariable OR of 1.69 (95% CI 1.24 to 2.31). The associations were similar for low-risk versus high-risk adenomas (size ≥1 cm, or with tubulovillous/villous histology, or ≥3 detected lesions), but appeared modestly stronger for proximal compared with distal adenomas. In contrast, recent antibiotic use within the past four years was not associated with risk of adenoma (p_trend=0.44). <h3>Conclusions</h3> Long-term antibiotic use in early-to-middle adulthood was associated with increased risk of colorectal adenoma.

LONG-TERM RESULTS OF TWO CASES OF BILATERAL HAND TRANSPLANTATION: LYON EXPERIENCE

O130 Aims: To report our experience about bilateral hand allotransplantation. Methods: The first bilateral hand transplantation was performed in January 2000 and the second case on April 30, 2003. The first recipient was a 33-year old man with bilateral amputation at midforearm level from four years and the second recipient was a 22-year old man with amputation at proximal forearm level on the right side and at wrist level on the left side from two years. The immunosuppressive protocol included tacrolimus, mycophenolate mofetil, prednisone and, for induction, antithymocyte globulins. An intensive rehabilitation program started 12 hours after surgery and included physiotherapy, electrostimulation and occupational therapy. Results: An arterial thrombosis, which was quickly reversed, occurred at day 1 post-transplantation in the second recipient. Side-effects included transient hyperglycemia during the first month post-transplantation in the first recipient and an ostheomyelitis at day 152 in the second patient with complete resolution after 6 months of antibiotics. During the follow-up period no malignancies occurred and no signs of graft-versus-host disease were shown in either patient. Only two episodes of acute skin rejection (asymptomatic maculopapular lesions) occurred on days 52 and 82 and on days 55 and 86 in the first and in the second recipient respectively. In all cases the episodes resolved by increasing oral steroid dose within 10-15 days. Nerve regeneration has been demonstrated by histological studies, electromyography and sensitive tests as well as cortical reorganization by functional magnetic resonance imaging in both patients. In the first bilateral hand transplantation there is a normal sensitivity to pain and thermal stimuli and a good sensitivity to dynamic and static pressure with some errors in discrimination of the localisation. Intrinsic musculature recovery started at 9 months and at present he can dissociate each single finger movement. His grip and pinch strength is 3 Kg and 1.5 Kg respectively. The patient is able to perform the same daily activities that were possible with the myoelectric prostheses before the transplantation. In addition, several activities such as holding a pen or a glass or a pair of scissors, shaving, taking care of his personal hygiene that were impossible before are at present easily performed by the patient. In the second bilateral hand transplantation there is a normal sensitivity to pain and thermal stimuli, a discrete tactile sensation and a discriminative sensation ranging between 8 and 15 mm. Intrinsic musculature recovery started at 6 months on the left side and at 9 months on the right side. His grip strength is 8 kg on the right and 10 Kg on the left side while his pinch strength is more than 1 kg on both sides. He is already able to take care of his personal hygiene and to hold several objects, such as a glass. Conclusions: Although these results are very encouraging, other cases are required.

A Retrospective Analysis of Treatment Outcomes and Time to Relapse after Intensive Medical Treatment for Chronic Sinusitis

Despite the high prevalence of chronic sinusitis, there are few published studies assessing its response to medical treatment. We analyzed, retrospectively, 40 patients seen in our center who were treated for chronic sinusitis with a protocol of intensive medical therapy. Both symptomatic and radiographic improvements were assessed as well as factors associated with early relapse. Intensive medical treatment consisted of 1 month of antibiotics, a short course of oral steroids, and adjunctive therapy (e.g., nasal irrigations plus intranasal steroids). After intensive medical therapy, adjunctive medical therapy was continued. A sinus computed tomography was performed at baseline and 6-8 weeks later and scored for extent of disease. Pre- and posttreatment symptom scores also were assessed. Time to relapse was defined as the time interval after antibiotic treatment at which a recurrence of symptoms necessitated reinstitution of antibiotics and/or oral steroids. Thirty-six of the 40 patients improved either symptomatically, radiographically, or both following the medical regimen. Twenty-six patients had sustained symptomatic benefit beyond 8 weeks after initial treatment. A statistically significant correlation was found between the change in pre- to posttreatment symptom scores and computed tomography scores. Using a log-rank test to compare rates of sinusitis relapse, nasal polyposis and a history of sinus surgery were significantly associated with earlier relapse (p = 0.006 and 0.018, respectively). In contrast, atopy, asthma, and persistent obstruction of the ostiomeatal unit were not associated with early relapse. Intensive medical treatment resulted in symptomatic and radiographic improvement in chronic sinusitis, and the majority of patients remained free of a relapse for >8 weeks. A history of nasal polyposis or previous sinus surgery was associated with earlier relapse of sinusitis symptoms. In contrast, the presence of atopy, a history of asthma, or persistent OMU obstruction was not associated with earlier relapse. Although long-term benefits have not been established, a prospective study of treatment outcomes from intensive medical treatment appears to be warranted.