Prolonged Antibiotic Therapy Research Articles

A retrospective study on the efficacy of neuro-endoscopic lavage compared to conventional antibiotic treatment in pyogenic ventriculitis.

Pyogenic ventriculitis (PV) is a severe and challenging infection with high morbidity, commonly associated with neurosurgical procedure. Conventional treatment involves prolonged antibiotic therapy and cerebrospinal fluid drainage but is associated with poor outcome. Neuro-endoscopic lavage (NEL) is a promising technique allowing direct reduction of bacterial load, which can potentially improve patient outcomes. This study aims to address the safety and efficacy of NEL. A retrospective cohort study was conducted on 22 patients with PV treated at West China Hospital from December 2019 to March 2024. Patients were divided into two groups: one receiving conventional therapy and the other undergoing NEL in addition to standard treatment. Primary and secondary outcomes, including clinical cure rate, mortality, and CSF sterilization, were analyzed. NEL significantly improved the clinical cure rate (83.33% vs. 40.00%, P = 0.0480). Although the 6-month mortality rate was not significantly different (P = 0.3233), NEL showed a trend toward faster recovery and a higher CSF sterilization rate. Neuro-endoscopic lavage significantly improves clinical outcomes in patients with pyogenic ventriculitis and represents a safe, preferred treatment option.

Spinal meningitis and abscess associated with dermal sinus tract: a case report

This case report discusses an 11-month-old male with a dermal sinus tract (DST) complicated by spinal meningitis and a long-segment intramedullary abscess. DSTs are rare congenital malformations that may remain asymptomatic until complicated by infections or neurological deficits. The patient was presented with prolonged fever and motor weakness in the extremities, leading to the discovery of a lumbosacral DST and associated abscess via cerebrospinal fluid (CSF) analysis and contrast-enhanced spinal Magnetic Resonance Imaging (MRI). Prompt surgical excision of the DST, drainage of the abscess, and prolonged antibiotic therapy resulted in significant clinical improvement. This case underscores the importance of early recognition, advanced imaging, and aggressive management to mitigate the severe neurological consequences of DST-associated infections.

P-889. Therapeutic Failures of High Inoculum Infections with Cefazolin: Role of A Rapid Test and Prevalence of the Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections

Abstract Background Cefazolin (CFZ) remains a key therapy for MSSA bloodstream infections (BSIs), yet some studies suggest poorer outcomes when CFZ is used in the presence of cefazolin inoculum effect (CzIE). We developed a rapid colorimetric test with nitrocefin to detect CzIE in MSSA. Here, we report the performance of the rapid test in four recurrent BSIs caused by MSSA exhibiting the CzIE. Furthermore, we assess the local prevalence of CzIE using both standard broth microdilution (BMD) and the rapid test. Methods A chart review collected clinical data from four patients, including demographics, microbiologic features, antibiotic therapies, and clinical outcome. Patients were selected based on positive MSSA BSI after initial clearance, and availability of their index isolate. The nitrocefin-based rapid test was performed according to a published protocol. For the surveillance step, MSSA were collected from initial cultures of adult patients diagnosed with BSIs between July 2023 and April 2024 from 8 hospitals. The CzIE was assessed using BMD at standard (105) and high (107) inocula, with a cutoff CFZ MIC ≥ 16 μg/ml. The rapid test was performed in all isolates. Results All four patients had deep-seated infections, including endocarditis, osteomyelitis, or device-related infections, with two patients undergoing surgical interventions. While receiving CFZ therapy, all patients successfully cleared their MSSA BSI. After initial clearance, these patients received prolonged antibiotic therapy lasting ≥ 6 weeks, with 3 of 4 patients continuing with CFZ, as part of their initial therapy. Despite this, MSSA BSI recurred between 34 and 155 days after initial hospitalization. Notably, all index isolates tested positive for CzIE via the rapid test. During the surveillance period, we collected 196 isolates, with a 40% (79/196) prevalence of the CzIE based on BMD. The rapid nitrocefin test correctly identified 72 of 79 strains exhibiting the CzIE, with 91% sensitivity and 80.3% specificity. Conclusion These findings underscore a high prevalence of MSSA isolates exhibiting CzIE in BSIs. Patients infected with MSSA displaying CzIE may face an increased risk for recurrence when treated with CFZ. Further validation of these observations is warranted to better understand their clinical implications. Disclosures José M Munita, MD, MSD: Grant/Research Support|Pfizer: Grant/Research Support William R. Miller, M.D., Merck: Grant/Research Support|UptoDate: Royalties

P-1570. D-mannose for Prevention of Recurrent Urinary Tract Infection in Adult Women: An Updated Systematic Review and Meta-analysis

Abstract Background Urinary tract infections (UTIs) are prevalent, especially among women as approximately 50% of all healthy women will encounter at least one episode of UTI during their lifetime. An estimated 25%-35% of them will experience a recurrence within the following year. Prolonged antibiotic therapy for prophylaxis of UTI poses the risk of antimicrobial resistance, alteration of normal flora, and high costs to the patient. D-mannose, a polysaccharide may reduce UTI by preventing the adherence of bacteria to uroepithelium by binding to the type1 pili and saturating the adhesin FimH. D-mannose is commonly marketed for urinary tract health and is touted to contribute to better antimicrobial management within primary care settings. We performed an updated meta-analysis comparing prophylaxis with D-mannose versus placebo or no treatment for prevention of recurrent UTI in adult women. Methods We systematically searched PubMed, Scopus, and Cochrane Central databases for trials comparing D-mannose versus placebo or no treatment for UTI prophylaxis in adult women. Outcomes of interest included one or more episodes of UTI within 6 months of randomization and adverse events. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline (Figure 1). Risk estimation for recurrent UTI Results The systematic review identified three randomized controlled trials including 846 participants. Prophylaxis with D-mannose was given to 428 (50.59%) participants. The risk of recurrent UTI within 6 months of randomization (RR 0.75; 95%CI 0.46-1.23; p=0.259; I2=52%) showed no significant difference between the groups (Figure 2). Adverse events (RR 0.81; 95%CI 0.09-6.91; p=0.847; I2=94%) were also similar between the groups (Figure 3). Risk estimation for adverse events Conclusion In contrast to a previous meta-analysis, our study found that prophylaxis with D-mannose did not reduce the risk of recurrent UTIs in adult women. Adverse events were also comparable between the groups. Disclosures All Authors: No reported disclosures

P-663. Evaluating the Effectiveness of a Real-Time Electronic Alert to Monitor the Duration of Antibiotic Therapy in Hospitalized Pneumonia Patients in the Asian Healthcare Setting

Abstract Background Limiting the duration of antibiotic prescribing to the shortest effective period is recognized as a strategy to mitigate the risk of antibiotic resistance. This study aims to assess the impact of a Real-Time Electronic Alert system designed to monitor the duration of antibiotic therapy in hospitalized pneumonia patients, with the goal of reducing unnecessary antibiotic exposure. Methods The intervention involved the implementation of a dashboard capable of generating real-time alerts whenever hospitalized patients diagnosed with community- or hospital-acquired pneumonia received antibiotics for more than five consecutive days. The study was conducted between December 2022 and January 2024 at two medical college hospitals in South Asia. Alerts generated by the dashboard were regularly reviewed by an antibiotic stewardship (AS) team, who intervened when patients exceeded the guideline-recommended duration of antibiotic therapy for pneumonia without additional clinical indications warranting continued antibiotic use. To evaluate the effectiveness of the intervention, the inappropriate duration of antibiotic therapy was compared before and after the implementation of the dashboard. A similar hospital with comparable patient demographics served as a comparative group. Results During the intervention period, the AS team reviewed a total of 218 patients flagged by the dashboard, resulting in 117 documented interventions. Reasons for lack of intervention included the presence of additional infection diagnoses necessitating prolonged antibiotic therapy, co-infections, and delayed clinical improvement. Post-implementation, the mean excess duration of antibiotic therapy for pneumonia decreased to 0.48 days compared to the pre-implementation mean of 2.13 days. In contrast, the comparative hospital, which did not employ the alert system, experienced a post-intervention mean excess duration of 1.97 days compared to a pre-intervention mean of 2.04 days. Conclusion The pneumonia dashboard represents a potentially valuable stewardship tool for reducing unnecessary antibiotic exposure in pneumonia patients. Disclosures All Authors: No reported disclosures

P-81. A Decade of Culture-Negative Native Vertebral Osteomyelitis: Insights from the Mayo Clinic

Abstract Background Culture-negative native vertebral osteomyelitis (CN-NVO) is increasingly common, rising from 0.3 to 1.8 cases per 100,000 between 1995 and 2008. The lack of microbial identification complicates optimal treatment and creates prognostic uncertainties. We describe our decade-long clinical experience with CN-NVO, focusing on patient characteristics, treatment, and outcomes. Patient Characteristics Methods We retrospectively analyzed adult patients with radiographic evidence of NVO between January 1, 2011, and July 31, 2021. CN-NVO required clinical indicators such as back pain and fever, elevated inflammatory markers, and negative cultures from at least one spine biopsy. Patients with infected instrumentation were excluded. Diagnostic Evaluation Values represent median, lower quartile, and upper quartile for continuous variables unless otherwise specified, 2 whereas frequencies and percentages are presented for categorical variables. ^ All results returned negative *Biopsies number two and three did not result in additional findings or change clinical management. Results Seventy-two patients were included. Their characteristics are presented in Table 1. Most (77.8%) had received antibiotics within the 4 weeks preceding the biopsy. Disc space enhancement on MRI was the primary finding, with the lumbar spine being the most frequently involved (Table 2). Blood cultures were positive in 39.4% of the patients within 3 months of symptom onset. Streptococcus spp. (n=9, median time between positive culture and diagnosis: 6.5 days [IQR 2.25, 26.75]) and Staphylococcus aureus (n=7, 40 days [IQR 37.5, 51.5]) were most common. Definitive antibiotics were administered in 98.6% of the cases, primarily IV β-lactam + vancomycin. Oral antibiotics (PO) were used in 46.5% of the patients, primarily as step-down therapy (91%) (Table 3). Surgery was required in 8.5% of the patients for abscess drainage or relief of spinal cord compression. Treatment failure occurred in 9.4% of patients, and 37.5% died during the median follow-up of 568.5 days, with two deaths related to the infection. Treatment and Outcomes ^ defined as requiring another course of antibiotics and/or surgery for suspected ongoing infection ¶ Clinical findings include back pain or fevers; laboratory findings indicate abnormal or uptrend in inflammatory marker values # Defined as MRI findings concerning ongoing or worsening infection as per the interpretation of the Radiologist, Infectious Disease physician, and/or Orthopedic Surgeon Conclusion Patients with CN-NVO often require prolonged antibiotic therapy, typically combination regimens, with favorable treatment outcomes. Our treatment failure rate is similar to other studies, although comparability may be limited by heterogeneity in definitions. Mortality rates in the range of 6 and 36% have been reported, with the higher end driven mostly by comorbidities. Enhanced diagnostics and standardized treatment protocols are needed to further improve patient outcomes. Disclosures All Authors: No reported disclosures

Comprehensive analysis of vaginal microbiota in Chinese women with genital tuberculosis: implications for diagnosis and treatment

BackgroundTuberculosis remains an infectious disease of global concern, with potential impacts on respiratory and intestinal microbiota owing to prolonged broad-spectrum antibiotic therapy. Despite its potential to cause infertility, the vaginal microbiota of women with genital tuberculosis remains poorly understood. We comprehensively analyzed the vaginal microbiota in Chinese women with genital tuberculosis.ResultsWe recruited women with pelvic (n = 28), endometrial (n = 16), and pulmonary (n = 12) tuberculosis as the research group, and healthy women (n = 11) as the control group. Vaginal discharges were collected for metagenomic analysis of its microbiota. The alpha diversity of the vaginal microbiota in women with genital tuberculosis was slightly higher than that in healthy women, though the difference was not statistically significant (P = 0.23). Similarly, no significant differences in alpha diversity were observed between women with genital and pulmonary tuberculosis (P = 0.82) or between those with pelvic and endometrial tuberculosis (P = 0.82). Notably, the lowest alpha diversity was recorded six months to one year after initiating anti-tuberculosis treatment, with this decline being statistically significant (P = 0.023). The dominance of Lactobacillus iners in the vaginal microbiota was more common in women with genital tuberculosis than that of Lactobacillus crispatus. Furthermore, the abundance of short-chain fatty acid -producing anaerobes, such as Actinomycetes, Streptococcus, and Finegoldia, were significantly increased. Short-chain fatty acid precursor pathways, including the ko03010 ribosome pathway, ko00970 aminoacyl-tRNA synthesis, ko00230 purine metabolism, ko00240 pyrimidine metabolism, and ko00010 glycolysis gluconeogenesis pathway, were significantly upregulated in women with endometrial tuberculosis.ConclusionsExtrapulmonary tuberculosis, particularly genital tuberculosis and its associated vaginal dysbiosis impacts female fecundity. Vaginal dysbiosis is more pronounced when M. tuberculosis invades the endometrium. Given the effect of antibiotics on vaginal flora, probiotic combined interventions could be used as a future research direction.Clinical trial numberNot applicable.

Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.

Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population. The emergence of growth-friendly techniques has greatly benefited patients with early-onset deformity, allowing for correction and control of deviation without interrupting trunk growth, which is often already compromised in these patients. We describe the surgical technique and present preliminary clinical outcomes for a novel approach which combines self-sliding screws that allow for trunk growth with impaction of translumbosacral rods for distal fixation. Candidates for the technique were patients with myelomeningocele and congenital lumbar kyphosis, inability to assume supine position, and a history of skin ulcers, recurrent osteomyelitis and poor weight gain. They all lacked sensory or motor function below the level of the myelomeningocele. They underwent the same reconstruction technique after kyphectomy which combines self-sliding screws that allow for trunk growth with impaction of the translumbosacral rods for distal fixation. Case 1: Female; 4.5years old at surgery; 5year follow-up. 1 complication: loosening of one blocker. The child is doing well and did not require surgical revision. Mean growth per year: 9.5mm. Case 2: Male; 7.4Years old at surgery; 4year follow-up. 1 complication: post-surgical infection which required 2 debridements in the operating room and prolonged antibiotic therapy. Mean growth per year: 6mm. Case 3: Female; 5.5Years old at surgery; 27month follow-up. No complications reported so far. Mean growth per year: 9.42mm. None of the cases showed signs of sacral osteolysis or rod migration. To our knowledge, this is the first study that combines sliding screws with translumbosacral rod impaction. Although this technique has proven to be safe and effective, we are aware that the number of cases is limited and the follow-up is short. Further studies are necessary to confirm the method.

Development and Validation of a Preclinical Canine Model for Delayed Onset Fracture-Related Infections

Background: Fracture-Related Infections (FRIs) are a challenging complication in orthopaedics. FRI incidence is considerably high, particularly in open fractures. FRI management typically involves multiple surgical interventions and prolonged antibiotic therapies. This regimen is often ineffective at infection eradication, resulting in poor outcomes and inefficient use of healthcare resources such that improved preventative and therapeutic interventions are needed. To effectively address these gaps, valid preclinical animal models for FRIs are needed. The purpose of this study was to develop and validate a canine ulna model for delayed FRIs that accurately mimics the clinical course noted in patients. Methods: In this model, a distal ulnar ostectomy was established, then internally stabilized with plates and screws that were pre-incubated with methicillin-resistant Staphylococcus aureus. After a 3-week period, all animals underwent irrigation and debridement of the fracture site followed by clinical, radiographic, bacteriologic, and histologic assessments over the subsequent 8 weeks. Results: This preclinical canine model established a valid representation of delayed FRI in patients based on clinical, radiographic, bacteriologic, and histologic features. Bilateral distal ulnar ostectomies stabilized with MRSA-incubated implants were consistently associated with clinical signs of local infection, radiographic evidence for delayed union with osteomyelitis and implant failure, and implant-associated biofilm formation 3 weeks after “fracture” creation. Conclusion: The translational rigor of the model allows for efficient and effective testing of novel preventive and therapeutic interventions aimed at improving outcomes for FRI patients.

Animal Models for Fracture-Related Infections: A Systematic Review

Background: Fracture-Related Infections (FRIs) are among the most challenging complications in orthopaedics. The incidence of these infections is high, particularly in complex, open fractures. FRI management typically involves irrigation and debridement of the fracture site, implant exchange and prolonged antibiotic therapy. This regimen is often ineffective resulting in poor patient outcomes and inefficient use of healthcare resources. As such, improved diagnostic, preventative and therapeutic interventions are needed. To effectively address these gaps, valid preclinical animal models that accurately replicate clinical FRIs are required. The purpose of this systematic review was to synthesize the relevant peer-reviewed literature related to FRI animal models to analyze their translational rigor and potential. Methods: An online database search was conducted using PubMed in which 77 articles were eligible for inclusion in this review. Results: Data extraction revealed a wide spectrum of animal species, methods for bone defect creation and fixation, bacterial inoculum deliveries and doses and intervention time points among the studies. Further, clinical, radiographic, microbiologic and histologic outcomes of infected control groups were assessed to determine validity of each model. Importantly, FRI-defining features such as bacterial biofilms and delayed fracture union were only reported in 20.8% and 29.9% of models, respectively. Conclusion: While it is challenging to incorporate and validate all clinically relevant components of FRIs into an animal model, many of the gaps identified in this systematic review can and should be addressed to improve the efficacy of preclinical evidence aimed at advancing FRI management. Keywords: Complex Open Fractures; Fracture-Related Infections; Fracture Management; Pre-Clinical Models; Animal Models

Pulmonary Mycobacterium avium infection in 2 domestic cats

Two domestic cats (Abyssinian and Carthusian) presented with chronic respiratory signs including cough, respiratory sounds, and polypnea. One of the cats also showed intermittent fever. Thoracic radiographs demonstrated severe changes with predominantly micronodular interstitial lung patterns, some with mineralized areas. Bronchoalveolar lavage detected high-grade pyogranulomatous airway inflammation. A cytological examination for acid-fast bacteria and a PCR for Mycobacteria species of the bronchoalveolar lavage fluid (BALF) were negative in both cats. A culture for Mycobacteria of the BALF detected Mycobacterium avium subspecies in both cats. While the clinical signs, but not the radiographic findings, could be controlled in one cat with prolonged double antibiotic therapy, the other cat developed septic peritonitis shortly after diagnosis and was euthanized. In unexplained chronic respiratory disease in cats, mycobacterial infection should be considered as a differential diagnosis. The breed of the first patient is consistent with the known predisposition for Abyssinians.

Necrotizing pneumonia-a rare but complex complication in bronchiectasis patients.

Pneumonia occurs commonly in bronchiectasis patients with exacerbation, though necrotizing pneumonia remains rare. This report presents two cases of bronchiectasis complicated by necrotizing pneumonia. The first case involves a 39-year-old female with bronchiectasis due to primary ciliary dyskinesia. She presented with severe chest pain and persistent fever unresponsive to oral antibiotics. Chest computed tomography (CT) revealed necrotizing pneumonia with associated empyema, necessitating prolonged antibiotic therapy, pleural drainage and ultimately surgical decortication. The second case is a 39-year-old male with bronchiectasis following ammonia inhalation injury, presenting with pleuritic chest pain and productive cough, with a CT scan showing consolidation with low attenuation areas. Intensive antibiotic treatment was required, alongside corticosteroids and inhaled antibiotics afterward. These cases demonstrate the importance of identifying risk factors for necrotizing pneumonia in bronchiectasis patients. Tailoring treatment strategies, including extending antibiotic regimens, using inhaled antibiotics, and administering corticosteroids, is essential to mitigate poor outcomes.

Empyema due to Actinomyces as a Diagnostic Challenge: A Case Report

Actinomycosis is a chronic, suppurative, and slowly progressive infection caused by anaerobic or microaerophilic, non-spore-forming Gram-positive bacilli belonging to the genus Actinomyces. This condition is challenging to diagnose as it requires anaerobic culture media. We present the case of an 80-year-old male patient diagnosed with loculated left empyema, treated surgically with decortication, along with prolonged antibiotic therapy, resulting in resolution of the case.

New Biocompatible Ti-MOF@hydroxyapatite Composite Boosted with Gentamicin for Postoperative Infection Control.

The standard clinical management of osteomyelitis involves prolonged antibiotic therapy, which frequently necessitates the excision of infected tissues. However, the efficacy of such treatments is increasingly compromised by the rise of antibiotic-resistant pathogens, underscoring an urgent need for innovative approaches. This study introduces a novel composite material designed to offer dual functionality: robust antimicrobial activity and promotion of bone regeneration. The composite integrates biocompatible hydroxyapatite nanoparticles (HA) with a titanium(IV)-metal-organic framework, MIL-125(Ti)-NH2, impregnated with gentamicin (GM). The solvothermally synthesized MIL-125-NH2@HA composite demonstrates high cytocompatibility, as evidenced by assays using osteoblasts (U2-OS) and fibroblasts (L929), alongside an absence of hemolytic activity at concentrations of up to 1000 μg/mL. Importantly, the introduction of GM into the composite significantly amplifies its antibacterial efficacy against Staphylococcus aureus and Pseudomonas aeruginosa. Additionally, nanoindentation assessments reveal enhanced mechanical properties of the MIL-125-NH2@HA composite, indicating the superior elastic performance relative to unmodified HA. The findings of this research are poised to generate significant interest in the development of metal-organic framework (MOF)-based composites for antimicrobial implant applications, presenting a promising avenue for addressing the challenges posed by antibiotic resistance in bone infections.

Peripherally inserted central venous catheter in outpatient antibiotic spinal infection treatment is safe, effective and leads to significant reduction in healthcare expenses

Prolonged antibiotic therapy is often recommended for the treatment of spinal infections. This study aimed to evaluate the efficacy and safety of outpatient intravenous (IV) antibiotic therapy for spinal neurosurgery patients with spondylodiscitis. We carried out a retrospective study involving 67 patients who were administered peripherally inserted central catheter (PICC) for IV antibiotic treatment from January 2020 to December 2022. We assessed patient data concerning infections and neurosurgical concerns. Each patient underwent a minimum of 6 weeks of IV antibiotics, both as inpatients and outpatients. The study included 67 patients with a median age of 61 years (SD +/- 14.18 years), with approximately 44% being female. The average hospital stay for inpatient treatment was 20 days (SD +/- 8.8 days). Subsequent outpatient antibiotic therapy lasted an average of 70.32 days (SD +/- 18.24 days), with outpatient IV therapy accounting for 44.74 days (SD +/- 9.15 days). The most common pathogens identified were Staphylococcus epidermidis and methicillin-sensitive Staphylococcus aureus. Microbiological analysis did not detect any pathogens in 18% of patients. Radiographic and laboratory evidence of spondylodiscitis was absent in 99% of patients during the final follow-up. No catheter-related complications occurred. Outpatient IV antibiotic therapy using a PICC line catheter is a safe and effective treatment option for spinal infections, especially in elderly patients.

Pulmonary actinomycosis complicating COVID-19 pneumonia in an immunocompetent patient: a case report.

Several co-infections have been described in the context of COVID-19 but only few cases of actinomycosis following SARS-CoV-2 infection have been reported in the literature. We report here the observation of a 48-year-old man, a smoker, who presented, in the aftermath of COVID-19 pneumonia requiring oxygen therapy a pyopneumothorax treated with antibiotic therapy and chest drainage. A few days later, he presented with hemoptysis. The diagnosis of actinomycosis was made based on histopathological data from endoscopic biopsies. The outcome was favorable under adapted and prolonged antibiotic therapy with amoxicillin. Pulmonary actinomycosis, although rare, should be suspected in front of lingering respiratory symptoms and/or atypical radiological findings in the context of a COVID-19.

Idiopathic granulomatous mastitis: a 5-year retrospective review of cases in a tertiary centre in Dublin, Ireland

AimsIdiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disorder of unknown aetiology usually affecting women of reproductive age. It classically presents as a unilateral painful breast mass. It...

Effects of clindamycin and amoxycillin as prophylaxis against early implant failure: double-blinded randomized clinical trial.

The objective of this randomized controlled clinical trial (RCT) was to compare the frequency of early implant failure, postoperative infection, and pain/inflammation and the degree of implant stability between healthy non-penicillin-allergic individuals receiving a single prophylactic dose of 600mg clindamycin versus 2g amoxicillin at 1h before implant surgery. A single-center double-blinded RCT study with parallel groups was undertaken. Eighty-two patients fulfilled study inclusion criteria and were randomly assigned to the amoxicillin (n = 41) or clindamycin (n = 41) group. The primary outcome variable was early implant failure. The presence of infection was evaluated immediately after surgery and on days 7, 14, 30, and 90, and postoperative pain/inflammation was assessed daily on days 1 to 7 post-surgery. Resonance frequency analysis was used to measure primary and secondary implant stability. One early implant failure was observed (1/81), in a patient from the amoxicillin group. No statistically significant between-group differences were observed in early implant failure rate, postoperative infection rate up to 90 days, pain/inflammation scores during the first week post-surgery, or primary or secondary stability values. A single dose of 600mg clindamycin before implant surgery does not increase the risk of early implant failure or infection. These findings suggest that a single dose of 600mg clindamycin at 1h before implant surgery is a safe antibiotic prophylactic approach; however, when a more prolonged antibiotic therapy is required, it appears advisable to prescribe an alternative antibiotic to avoid adverse effects.

Symptoms after Lyme disease: What's past is prologue.

Protracted fatigue and other symptoms can occur after Lyme disease and other infections, with numerous possible drivers. Studies on posttreatment Lyme disease have been inconclusive, with no confirmed biomarker emerging. Prolonged antibiotic therapy provides no benefit. Thus, a holistic approach toward understanding and treating this complex disease is necessary.

Actinomycosis of the gallbladder: A rare case report and literature review

Actinomycosis of the gallbladder is rare, with only a few documented cases in the medical literature. Actinomyces is typically part of the normal flora of the cervicofacial region, gastrointestinal tract, and urogenital tract. Here, we report a case of a 31-year-old female who presented with pain abdomen. Radiological investigation revealed a contracted gallbladder with multiple calculi and a thickened wall. A provisional diagnosis of acute cholecystitis was considered preoperatively and hence planned for laparoscopic cholecystectomy. Histopathological examination showed moderate lymphocytic infiltrate within the muscular layer of the gallbladder along with colonies of filamentous bacteria suggestive of actinomycosis. The relevant stains, including Gram and Giemsa, highlighted the Gram-positive bacteria and confirmed the diagnosis. Post-cholecystectomy, the patient received prolonged antibiotic therapy to prevent recurrence.