Signs Of Systemic Infection Research Articles

Blood Conservation

Blood Conservation

Percutaneous Endoscopic Gastrostomy in Children

Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide nutritional support for patients with normal gastrointestinal function but cannot be fed orally for a variety of reasons. Owing to safety concerns, the first feeding after PEG tube placement is generally delayed. Early feeding may be an option; however, childhood studies regarding early feeding after the PEG procedure are highly insufficient. A prospective randomized controlled study was conducted to compare early (4th hour) and late (12th hour) feeding after the PEG procedure. The PEG process was performed with the standard pull technique. Prophylactic antimicrobial drugs were not used. Complications such as gastric residue after feeding, vomiting, fever, systemic signs of infection, and duration of hospital stay were recorded. Tube feeding training was given to parents during their stay in the hospital in both groups. In the first and third days following PEG, the patients were visited by an experienced nurse in their homes and evaluated in terms of potential complications. The study was completed with a total of 69 patients: 35 in the early feeding group and 34 in the late feeding group. The demographic characteristics of the groups were similar. Vomiting was rare and detected as similar in both groups (early feeding group 8.5% [3/35], late feeding group 8.8% [3/34], P = 1.00). Rarely, minor gastric residue was observed in both groups (early feeding group 11.4%, late feeding group 8.8% [P = 1.00]). The amount of gastric residue in the early feeding group was a maximum of 13.2 mL, whereas the late feeding group had a maximum of 14.3 mL. The average duration of stay in the hospital for the early and late feeding groups was calculated as 6.7 ± 0.64 and 28.3 ± 3.74 hours, respectively (P < 0.001). Leakage from gastrostomy fistulas, peritonitis, and aspiration were not observed in any patients. The feeding at the fourth hour after PEG placement was safe and well tolerated by patients and shortened the duration of the hospital stay. The use of prophylactic antibiotics seems to be unnecessary before the procedure.

Predictors of Organ Failure and Role of Early ERCP in Hospitalized Patients with Acute Cholangitis

Purpose: Acute cholangitis is considered a medical emergency and predictors associated with organ failure are not well defined. Furthermore, the impact of early endoscopic retrograde cholangiopancreatography (ERCP) on outcomes in hospitalized patients with cholangitis is unclear. The aim of the study is to examine clinical outcomes and identify predictors associated with persistent organ failure in hospitalized patients with acute cholangitis. Methods: Consecutive hospitalized patients who received ERCP at Loma Linda University Medical Center for suspected cholangitis between 4/2005-3/2013 were identified by reviewing an internal endoscopy database. Cholangitis was defined by radiographic evidence of biliary obstruction and signs of systemic infection (fever, leukocytosis, bacteremia, and/or purulent bile drainage during ERCP). Primary outcome was persistent organ failure at >48 hours from hospitalization (≥1.5 times rise in creatinine levels from baseline values to ≥1.5 mg/dL, or need for dialysis, mechanical ventilation, and/or hypotension requiring vasopressor). Results: A total of 167 patients who underwent ERCP for indication of suspected cholangitis met the inclusion criteria. The mean age was 60±19 years; 70% were male. On presentation, 86 (51%) patients demonstrated Charcot's triad, 58 (35%) had bacteremia, and ERCP was performed at a median of 41 hours (range, 0-927 hours) from hospitalization. The cause of cholangitis included common bile duct stone in 87 (52%) patients, biliary stent dysfunction in 46 (28%), and malignant stricture in 12 (7%). Initial biliary decompression with ERCP was accomplished in all but 11 patients (7%), and 4 (2%) developed ERCP associated complications (pancreatitis in three, post-sphincterotomy bleeding in one). Clinical outcomes of the 167 patients with cholangitis are shown in Table 1. On multivariate analysis, patients with Charlson Comorbidity Index >2 (odds ratio [OR] 14.0; 95% confidence interval [CI] 2.9-69.0; P=0.001) and 1-2 (OR 6.9; 95% CI 1.3-36.9; P=0.02) compared to zero, presence of systemic inflammatory response syndrome (SIRS; OR 3.7; 95% CI 1.6-8.7; P=0.002), and ERCP performed ≥48 hours (OR 3.2; 95% CI 1.4-7.9; P=0.006) compared to <48 hours from presentation were associated with persistent organ failure.TableConclusion: Delayed performance in ERCP was associated with persistent organ failure in hospitalized patients with acute cholangitis after adjusting for medical comorbidity and SIRS. Early ERCP performed <48 hours from presentation in patients with suspected cholangitis may improve outcomes.

Adenosine-Mediated Enteric Neuromuscular Function Is Affected during Herpes Simplex Virus Type 1 Infection of Rat Enteric Nervous System

Adenosine plays an important role in regulating intestinal motility and inflammatory processes. Previous studies in rodent models have demonstrated that adenosine metabolism and signalling are altered during chronic intestinal inflammatory diseases. However, the involvement of the adenosinergic system in the pathophysiology of gut dysmotility associated to a primary neurodysfunction is still unclear. Recently, we showed that the neurotropic Herpes simplex virus type-1 (HSV-1), orally inoculated to rodents, infects the rat enteric nervous system (ENS) and affects gut motor function without signs of systemic infection. In this study we examined whether changes in purinergic metabolism and signaling occur during permanent HSV-1 infection of rat ENS. Using isolated organ bath assays, we found that contraction mediated by adenosine engagement of A1 or A2A receptors was impaired at 1 and 6 weeks post-viral administration. Immunofluorescence studies revealed that viral infection of ENS led to a marked redistribution of adenosine receptors: A1 and A2B receptors were confined to the muscle layers whereas A2A and A3 receptors were expressed mainly in the myenteric plexus. Viral-induced ENS neurodysfunction influenced adenosine metabolism by increasing adenosine deaminase and CD73 levels in longitudinal muscle-myenteric plexus with no sign of frank inflammation. This study provides the first evidence for involvement of the adenosinergic system during HSV-1 infection of the ENS. As such, this may represent a valid therapeutic target for modulating gut contractility associated to a primary neurodysfunction.

Journal Scan

Journal Scan

Using Evidence to Improve Care

Evidence-based care uses the best research and individual expertise to make decisions with patients. Although much of the focus to date has been on generating evidence from high-quality research such as randomized clinical trials (RCTs)1, the next critical step is to ensure that the evidence is applied to the care of patients. This article used an evidence-based practice guideline and a multidisciplinary team to improve the care of children with osteomyelitis. Osteomyelitis is a relatively common pediatric orthopaedic issue that has become increasingly problematic because of the emergence of virulent and treatment-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). Osteomyelitis can be classified as complicated or uncomplicated. Uncomplicated osteomyelitis typically has a short duration of symptoms, minimal local clinical signs, and no radiographic changes, and responds rapidly to antibiotics. Complicated osteomyelitis presents late or has a short, rapidly progressive course, with local signs of an abscess, systemic signs of infection, extensive soft-tissue involvement, and radiographic changes, and usually requires operative intervention with prolonged antibiotic therapy. Failure to adequately treat osteomyelitis not only leads to prolonged hospitalization, but also may result in permanent disability and/or chronic infection. As evidenced by the experience of the …

Commentary on ‘Outcomes of Infected Abdominal Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort’

In this paper, Maze et al. report a series of 18 patients treated for aortic graft infection over a period of 11 years. Only one of them, presenting with an aortoduodenal fistula, was treated surgically as a first intention, while the other 17 were treated conservatively, despite the fact that 11/18 (61%) showed signs of systemic infection. The only patient initially treated surgically with complete graft removal remained alive 128 months after treatment. Of the 17 patients treated with antimicrobial therapy and graft retention, there was a recurrence of infection in almost 60% (10/17). A quarter of these patients died as a result of the first relapse episode. Surgery was performed in 35% (6/17) of patients initially treated conservatively. Of note also is that for patients treated by non-operative management the overall survival rate was 1/9. Although this article aimed to investigate the assumption that conservative management may be an alternative to graft removal with or without revascularization, there are several issues to be considered before reaching a conclusion from the data presented.

Infections secondary to pacemaker implantation : a synopsis of six cases : case report - online article

Permanent cardiac pacing is a technique whose indications have increased in the last 20 years. As with any foreign body, pacemaker implantation is associated with the risk of infection. The objective of this study was to describe the clinical, paraclinical and treatment options of infections secondary to pacemaker implantation at the Cardiology Department of the Aristide le Dantec Teaching Hospital (CHU Aristide le Dantec) in Dakar, Senegal. We conducted a retrospective study over a period of three years (from January 2005 to December 2007) during which pacemaker implantation was carried out in 107 patients. All patients with local and/or systemic signs of infection were included in our study. The prevalence of infection in patients with pacemakers was 5.6% in our series and infection occurred in three women and three men, with a mean age of 66.2 years (range 23-83). The delay time for the onset of clinical signs of infection was 6.6 months, with a range of eight days to 12 months. The clinical signs were externalisation of the pacemaker with suppuration (five cases), fever (one case) and inflammatory signs (one case). Factors favouring the occurrence of infection were co-morbidity (four cases), pre-operative length of stay (average eight days), use of temporary cardiac pacing (three cases), the number of people in the theatre (average 4.5), postoperative haematoma (one case) and repeating the surgical procedure (three cases). Staphylococcus epidermidis (two cases), Staphylococcus aureus (two cases) and Klebsiella pneumonia (one case) were the organisms isolated at the local site. Transthoracic echocardiography showed no objective signs of endocarditis. The treatment was antibiotic therapy for an average duration of 50.4 days after debridement of the infected site (six cases). We noted four recurrences at six months and one death from sepsis at 12 months. Infections secondary to pacemaker implantation are rare but serious. Their management is difficult and requires the removal of the implanted material, hence the importance of prevention of infection, or the removal and re-implantation of the pacemaker at another site in cases of infection. This is particularly important in our region where pacemakers are very expensive.

Mucormycosis in a liver allograft: salvage re‐transplantation and targeted immunosuppressive management

Zygomycetes infection is associated with a high mortality in transplant populations. We describe a child with liver allograft Rhizopus oryzae infection who was salvaged by liver re-transplantation. A 10-year-old child presented with anastomotic bile leak that was repaired. A combined antibiotics and voriconazole regimen was introduced for Escherichia coli and Candida krusei growth in the peritoneal fluid. Despite broad antibiotic and antifungal coverage, the patient continued to have an ongoing infection. A follow-up computed tomography scan 8weeks later showed 2 liver abscesses infiltrating the stomach and the diaphragm, with splenic infarcts and pericardial effusion. Aspirated samples from the liver abscess and the pericardial fluid revealed R. oryzae. Immunosuppression was discontinued and an antifungal regimen combining amphotericin B, posaconazole, and caspofungin was introduced. After 3weeks of treatment with control of the systemic signs of infection, a positron emission tomography showed the fluorescence stain limited to the liver. With infection confined to the liver, the child underwent liver re-transplantation, splenectomy, and partial gastrectomy. Immunosuppression was reintroduced with recovery of the immune response observed by the CD4 cells adenosine triphophate release (Cylex(™) ImmuKnow(®) assay) and posaconazole was continued for another year. At 3-year follow-up, the child maintained normal graft function. We conclude that discontinuation of immunosuppression combined with a modern antifungal regimen may allow salvage re-transplantation in patients with liver mucormycosis.

Serum Procalcitonin Levels in Patients With Myeloperoxidase-Antineutrophil Cytoplasmic Antibodies-Associated Glomerulonephritis

High serum procalcitonin (PCT) levels (≥0.5 ng/mL) commonly occur with systemic bacterial and fungal infections. Although several studies suggested that measuring serum PCT levels may serve as a useful marker to distinguish between active antineutrophil cytoplasmic antibodies (ANCA)-associated diseases and invasive infections, there is no information on PCT in myeloperoxidase (MPO)-ANCA-associated glomerulonephritis. The authors measured serum PCT concentrations before initiation of immunosuppressive therapy in 67 patients with biopsy-proven MPO-ANCA-associated glomerulonephritis. The authors compared complications and clinicopathological parameters between patients with serum PCT levels of <0.5 ng/mL (group A: 58 patients) and ≥0.5 ng/mL (group B: 9 patients). All 58 patients in group A did not show any clinical sign of systemic infection. On the other hand, 3 of 9 patients in group B had bacterial or fungal infections of the respiratory or urinary tact. One patient had a history of chronic urinary tract infection. In the remaining 5 patients in group B, there were 3 patients with concurrent malignancies and 1 postoperative patient with malignancy. Another in group B had a long history of interstitial pneumonia of unknown origin and severe renal insufficiency. Serum levels of C-reactive protein and creatinine were significantly higher in group B than in group A. In patients with MPO-ANCA-associated glomerulonephritis, serum PCT levels of ≥0.5 ng/mL are recommended as cutoff for consideration of bacterial and fungal infections. Elevated serum PCT levels could also be observed in some patients with severe injury of the kidneys and/or lungs in the absence of infection.

The Role of MRI in Diagnosis of Diabetic Muscle Infarction : an Underdiagnosed Entity

: Muscle infarction is an uncommon complication of long-standing diabetes mellitus. Here, we report the case of a 62-year-old diabetic male patient with acute pain and swelling of the right thigh with signs of mild inflammation but no evidence of infection or myopathy. Initial magnetic resonance imaging (MRI) revealed diffuse swelling and edema of quadriceps muscles with blurred margins. The clinical symptoms showed significant improvement after 1 month of symptomatic treatment. Follow-up MRI performed after 3 months showed remarkable improvement in inflammatory changes with mild residual swelling and edema of the vastus lateralis muscle. In the absence of any systemic signs of infection and laboratory diagnostic markers, the detection of typical features such as hyperintense signal on T2 weighted images or hypo- to isointense signals on T1 weighted images, without localized fluid collection, remains the most useful investigative tool for diagnosing diabetic muscle infarction and obviates the need for invasive procedures like muscle biopsy. Diabetic muscle infarction is a rare complication with distinct clinical presentation, laboratory findings, and MRI features, and can be resolved over a period only by administering adequate supportive treatment. Clinicians should be aware of this complication and always consider it in the differential diagnosis of diabetic patients presenting with acute onset of pain and swelling of the extremities. Implication for health policy/practice/research/medical education:No direct relation for health policy. Knowledge about the role of MRI in the management of this complication of diabetes will help the Physicians and unnecessary surgical interventions may be avoided. There is scope for research on drugs which can prevent and treat this complication. Please cite this paper as:Goswami P, Baruah MP. The Role of MRI in Diagnosis of Diabetic Muscle Infarction : an Underdiagnosed Entity. Int J Endocrinol Metab.2011;9(2):353-5. DOI: 5812/kowsar.1726913X.1886 Copyright© 2011 Kowsar M.P.Co. All rights reserved.

Streptococcal toxic shock-like syndrome (TSLS)

Toxic shock syndrome (TSS) is a rare, toxin-mediated acute life-threatening illness, usually precipitated by infection with either Staphylococcus aureus or group A Streptococcus (GAS), also called Streptococcus pyogenes. We present a case of 37-year-old male immunocompetent Caucasian who was hospitalized at the Clinic for Infectious Diseases because of diarrhea and vomiting with no signs of systemic infection. The symptoms disappeared after parenteral rehydration. Two days after the short lived improvement, the patient was highly febrile (40°C) with subicteric and petechial skin changes. Rapidly, respiratory, renal as well as psychical failure was observed with tachypnea, oliguria and finally anuria. Blood studies revealed inflammatory response and the indicators of hepatic and renal failure were high. Blood culture was positive on Streptococcus pyogenes. Although therapy procedures were initiated, acute respiratory distress syndrome had developed and the patient was intubated at Intensive Care Unit. Roentgenogram of the chest showed metastasis of infection, pleural effusion, and heart enlargement. The ECG showed changes characteristic of pericardial effusion as well as septal fibrosis. Splenomegaly was confirmed with computed tomography. After four weeks of treatment and further monitoring the patient was discharged from hospital in good general condition, stable vital functions and normal findings on physical systems. This was the first case of toxic shock-like syndrome described in the Department for Infectious Diseases of Clinical Center in Kragujevac.

Endograft Repair of Aortic Anastomotic Aneurysms

Anastomotic aneurysms (AA) are a known complication of aortic reconstruction. Although rupture risk is not clearly defined, open surgical repair does carry considerable risk. Patients typically present many years later, possibly placing them in a more medically-compromised conditions than existed at the time of original repair. Endovascular repair of AA has been described, but management of contiguous patent vessels, maintenance of antegrade flow in critical vessels, and access issues can add additional complexity. We describe four cases of endovascular AArepair (3 male, 1 female). All original reconstructions were for occlusive disease. An average of 2 AA/patient was present. All grafts were Dacron with proximal configuration being either end-to-side (3) or end-to-end (1). Mean patient age was 75, exhibiting an average of 15 years from original procedure to AA diagnosis. No patient exhibited signs of systemic infection. All patients were studied by computerized tomographic angiography (CTA) followed by catheter angiography and any contiguous patent vessel, i.e. distal aorta or iliac, communicating directly with the AA was treated by percutaneous placement of coils and/or bilobed-occlusion plugs. Definitive AA repair was later accomplished using conventional bifurcated endografts and/or extension cuffs. Selective hypogastic revascularization and alternative delivery access sites were also employed when physiologically and anatomically necessary. All cases were successfully carried out with widely-patent axial flow maintained and without need for extra-anatomical reconstruction. No peri-procedural endoleak or complications were seen. Postoperative hospital stay averaged 1.3 days. At follow-up period ranging from 4-43 months, all patients are alive, asymptomatic and with excluded AA demonstrated by CTA. No infectious issues have developed. Appropriate imaging and treatment planning allowed for successful endovascular repair of 4 proximal anastomotic aneurysms. Treatment adjuncts such as coils, plugs, alternative access sites and selective hypogastric reconstruction allowed for uneventful repair with conventional endografts and cuffs. Durable repair without morbidity and rapid recovery was seen in all cases. Endovascular AA repair offers an attractive alternative to open repair, especially for the older, more fragile patient.

High Frequency of Tropheryma whipplei in Culture-Negative Endocarditis

"Classical" Whipple's disease (cWD) is caused by Tropheryma whipplei and is characterized by arthropathy, weight loss, and diarrhea. T. whipplei infectious endocarditis (TWIE) is rarely reported, either in the context of cWD or as isolated TWIE without signs of systemic infection. The frequency of TWIE is unknown, and systematic studies are lacking. Here, we performed an observational cohort study on the incidence of T. whipplei infection in explanted heart valves in two German university centers. Cardiac valves from 1,135 patients were analyzed for bacterial infection using conventional culture techniques, PCR amplification of the bacterial 16S rRNA gene, and subsequent sequencing. T. whipplei-positive heart valves were confirmed by specific PCR, fluorescence in situ hybridization, immunohistochemistry, histological examination, and culture for T. whipplei. Bacterial endocarditis was diagnosed in 255 patients, with streptococci, staphylococci, and enterococci being the main pathogens. T. whipplei was the fourth most frequent pathogen, found in 16 (6.3%) cases, and clearly outnumbered Bartonella quintana, Coxiella burnetii, and members of the HACEK group (Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). In this cohort, T. whipplei was the most commonly found pathogen associated with culture-negative infective endocarditis.

Bacillus Calmette-Guérin-related cold thigh abscess as an unusual cause of thigh swelling in infants following BCG vaccine administration: a case series

IntroductionThigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis.Case presentationsWe performed a retrospective review of five infants (four boys and one girl) who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60%) received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients.ConclusionsTechnical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.

ANTIMICROBIOLOGICAL EFFECTS OF NEW NATURAL ANTISEPTIC FORMULATION ON NON-INFECTED VENOUS LEG ULCER: PILOT STUDY

Venous leg ulcers represent a significant public health problem that will increase as the population ages. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as antimicrobial, antifungal, astringent etc. The aim of the study was to establish the in-vivo antimicrobial effects of herbal hydrogel formulation DermaplantG. The major components of the DermaplantG were the extracts of Allii bulbus, Hyperici herba and extract of Calendulae flos. A total of 12 patients with non-infected venous leg ulcers were treated twice daily, for 5 weeks, with new hydrogel formulation. All ulcers showed clinical signs of contamination or colonization without signs of systemic infection. Premoistening the swab with sterile saline was considered when the surface of the wound was dry. The tip of the swab was rolled on its side in a zigzag pattern for at least one full rotation. Standard methods for isolation and identification of aerobic and anaerobic bacteria were used. On baseline assessment, a large number of different types of bacteria were detected in all venous leg ulcers. S. aureus and P. aeruginosa were isolated from almost all controls. On baseline, mixed bacterial flora (50%) was isolated in six venous leg ulcers (five ulcers with S. aureus-P. aeruginosa and one ulcer with E.coli-Enterobacter sppP.aeruginosa). At the end of the treatment in DermaplantG group in 8 venous ulcers were detected S. aureus (66.66%) and P. aeruginosa (16.66%), and one venous leg ulcers was detected as sterile (8.33%). The number of different types of isolated bacterial species decreased significantly (P<0.05) after the use of DermaplantG herbal preparations. Therapy in DermaplantG group was administered without any side effects. The preliminary results of this pilot study demonstrate potential antimicrobial effects of herbal therapy on non-infected venous leg ulcers. Acta Medica Medianae 2011;

Complications des gastrostomies percutanées (hors complications immédiates)

The most frequent complications following percutaneous gastrostomies are those occurring around the tube insertion site (leakage, purulent secretions and excessive granulation tissue) or those involving deterioration of the gastrostomy tube. These complications are usually benign; rarely, peristomial wound infection can present as a necrotizing fasciitis. In most cases, local antiseptic care and antibiotherapy are sufficient to control peristomial wound infection. In case of systemic signs of infection, parenteral antibiotherapy is indicated.

Clinical comparison between exogenous and haematogenous periprosthetic joint infections caused by Staphylococcus aureus

Patient-related risk factors for invasive Staphylococcus aureus infection overlap with those for periprosthetic joint infections (PJIs). We compared these factors and clinical characteristics between 17 exogenous and 40 haematogenous PJIs caused by S. aureus. Exogenous cases presented significantly more often with damaged periprosthetic soft tissue, whereas haematogenous cases more often had systemic signs of infection, such as fever, chills, and sepsis syndrome. However, comorbid conditions associated with S. aureus infection and/or PJIs did not differ between the two groups. These findings imply that patient-related risk factors for S. aureus infection do not help to predict the mode of infection acquisition in prosthetic joints.

Preventing Staphylococcus aureus Bacteremia and Sepsis in Patients With Staphylococcus aureus Colonization of Intravascular Catheters

Two previous studies in tertiary care hospitals identified Staphylococcus aureus colonization of intravascular (IV) catheters as a strong predictor of subsequent S. aureus bacteremia (SAB), even in the absence of clinical signs of systemic infection. Bacteremia was effectively prevented by timely antibiotic therapy. We conducted this study to corroborate the validity of these findings in non-university hospitals.Using the laboratory information management systems of the clinical microbiology departments in 6 Dutch hospitals, we identified patients who had IV catheters from which S. aureus was cultured between January 1, 2003, and December 31, 2008. Patients with demonstrated SAB between 7 days before catheter removal and 24 hours after catheter removal were excluded. We extracted clinical and demographic patient data from the patients' medical records. The primary risk factor was initiation of anti-staphylococcal antibiotic therapy within 24 hours, and the primary endpoint was SAB >24 hours after IV catheter removal. Subsequently, we performed a systematic review and meta-analysis of all observational studies evaluating the effect of antibiotic therapy for S. aureus IV catheter tip colonization.In the current study, 18 of the 192 included patients developed subsequent SAB, which was associated with not receiving antibiotic therapy within 24 hours (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.1-15.6) and with documented exit-site infection (OR, 3.3; 95% CI, 1.2-9.3). When we combined these results with results of a previous study in a university hospital, a third risk factor was also associated with subsequent SAB, namely corticosteroid therapy (OR, 2.9; 95% CI, 1.3-6.3). We identified 3 other studies, in addition to the present study, in a systematic review. In the meta-analysis of these studies, antibiotic therapy yielded an absolute risk reduction of 13.6% for subsequent SAB. The number needed to treat to prevent 1 episode of SAB was 7.4.We conclude that early initiation of antibiotic therapy for IV catheters colonized with S. aureus prevents subsequent SAB.

Aspects IRM de la tuberculose de la région sellaire

Purpose Tuberculosis of the sellar region, especially the pituitary gland, is rare. The purpose of this article is to demonstrate through a review of five clinical cases the value of imaging, especially MR imaging, in the evaluation of this pathology. Patients and methods CT and MRI of the brain were obtained in all cases along with a chest radiograph. Results Four patterns were detected on MRI: pituitary tuberculoma mimicking adenoma; pituitary abscess, extending to the cavernous sinus in one case and associated with infundibulum thickening in another; hypophysitis with suprasellar extension in association with tuberculous meningoencephalitis; and infundibular thickening associated with tuberculous meningoencephalitis. Diagnosis was based on biopsy in two cases and combination of imaging and clinical data in three cases. Outcome was favorable with anti-tuberculosis drugs. Conclusion Irrespective of the imaging features, a history of travel to an endemic region combined to other findings such as infundibular thickening should raise concern for the possibility of tuberculosis even in the absence of signs of systemic infection.