Doxycycline release from cyclodextrin oligomer-containing collagen gels.

Intracortical microelectrodes allow for the recording of neural signals in the brain but show decreased recording performance over time. This failure is due primarily to the neuroinflammatory response triggered by microelectrode implantation. We have shown that one consequence of the disruption of the blood-brain barrier following microelectrode probe implantation is the invasion of non-native bacteria to the implant site, which exacerbates the neuroinflammatory response. This study investigates the effects of coating non-functional silicon intracortical microelectrodes with an antimicrobial titania nanotube array (TNA) to reduce the relative abundance of invasive microbes and the resulting neuroinflammatory response. TNA-coated probes were implanted into mice for either 4 weeks (N=4) or 12 weeks (N=4) and compared to uncoated probes at both time points. We found that the TNA coatings reduce microbe relative abundance at both acute and chronic time points, correlating with fewer significantly expressed neuroinflammatory markers. Coating probes with TNAs allows for the beneficial effects of the antimicrobial coating to persist to chronic time points, in contrast to the detrimental effects of chronic systemic antibiotic administration reported previously. This study establishes antimicrobial TNA coatings as a platform for controlling the microbial environment, reducing invasive bacteria and neuroinflammation at the implant site. By mitigating the neuroinflammatory response, TNA-coated probes address one of the key contributors to intracortical microelectrode failure, thereby providing a strong platform that may support improved chronic recording performance in future functional intracortical microelectrode applications.

Pustular mycosis fungoides (pMF) is a rare variant of MF characterized by the clinical and histopathological formation of pustules. We report a 71-year-old Japanese woman with established MF who developed a generalized pustular eruption temporally triggered by systemic interferon (IFN)-γ administration. Clinically, the patient presented with generalized erythema with coalescing pustules mimicking generalized pustular psoriasis or acute generalized exanthematous pustulosis. Histological examination revealed the simultaneous presence of spongiform pustules of Kogoj and large transformed CD30+ atypical lymphoid cells. The pustules resolved rapidly upon the discontinuation of IFN-γ and the administration of systemic antibiotics. Cytokine analysis at the onset of pustulosis revealed marked elevations in serum IL-8, IL-18, IL-23, and IL-6 compared with healthy controls; these levels normalized during remission. This case suggests that systemic IFN-γ can act as a trigger for pMF. Furthermore, the distinct cytokine profile highlights that the IL-23/IL-17/IL-8 axis may be a crucial mediator in the pathogenesis of pMF.

Surgical-site infections (SSIs) represent a significant healthcare burden, often complicating wound healing and recovery. To overcome the limitations of systemic antibiotic administration, such as toxicity and poor localization, this study aimed to develop a bioactive dressing utilizing bacterial nanocellulose (BNC) impregnated with gentamicin-loaded chitosan nanoparticles (GNP). Chitosan nanoparticles were synthesized via ionic gelation with sodium tripolyphosphate (TPP) and optimized using a one-factor-at-a-time (OFAT) approach to control particle size, polydispersity index (PDI) and zeta potential. The optimized nanoparticles were impregnated into BNC disks, and the resulting composite was characterized using FTIR and Raman spectroscopy, XRD and SEM. Antimicrobial efficacy was evaluated against Klebsiella pneumoniae, while biocompatibility was assessed using MTT assays and cell-adhesion studies on human fibroblasts. The optimization process yielded stable, monodisperse nanoparticles with a mean size of 80.07 nm and a PDI of 0.192. SEM imaging confirmed the successful integration of nanoparticles into the BNC nanofibrillar network without compromising the membrane's structural integrity. The BNC-GNP composite demonstrated significant antimicrobial activity against K. pneumoniae, comparable to free gentamicin solution. Furthermore, in vitro studies revealed good biocompatibility, with cell viability exceeding 70% and sustained fibroblast adhesion, although cell-attachment density decreased with higher nanoparticle concentrations. The developed BNC dressing containing gentamicin-loaded chitosan nanoparticles presents a promising multifunctional biomaterial. It effectively combines local infection control with a biocompatible environment suitable for tissue regeneration, offering a novel approach for the postoperative treatment of surgical-site infections.

Abstract Treatment of periodontal pathologies has a local but also systemic nature in cases where it is indicated after complete scaling performed in several stages. Seen from this perspective, it is very important to note that the administration of systemic anti-biotics should be carried out only after the final stage of local periodontal scaling, taking into account that any remnants of periodontal calculus on the surface of the teeth where periodontal therapy is being performed must be removed. About 52% of the selected articles in this review emphasize that antibiotics are given for prophylactic treatment before dental interventions; in 20% of cases the systemic administration of antibiotics is indicated for periodontal pathologies, while in 12% of cases it is indicated for endodontic pathologies. If we review these values again so that both antibiotics and alternative treatment are applied, it is noted that systemic treatment is performed in 36% of cases, while local treatment with both antibiotics and alternative treatment is performed in 20% of cases. The systemic dosage of antibiotics for dental prophylaxis is still the most common, reaching a value of 28%. Systemic antibiotics are most frequently indicated for administration in prophylactic dental treatment and periodontal pathologies – much more frequently than in cases of endodontic pathologies. For periodontal pathologies, scientific research is oriented towards alternative treatment methods instead of systemic administration of antibiotics effective against the specific pathogen of the pathologies. There are no articles that juxtapose two alternative treatment methods with one another, since all articles emphasize the well-known facts that there is bacterial resistance and there are side effects of antibiotics and the alternative treatment method is compared with the basic methods of non-surgical periodontal treatment.

Implant-associated infections remain a major clinical challenge, often leading to implant failure, revision surgery, and increased healthcare burden. Systemic antibiotic administration is limited by poor local bioavailability and systemic side effects, highlighting the need for localized drug-delivery systems that can simultaneously support tissue integration and prevent bacterial colonization. This study aimed to develop and characterize a novel generation of chitosan membranes loaded with hydroxyapatite–clindamycin phosphate (CS/HA-CLY) for localized infection prevention at implantation sites. The composite membranes’ physicochemical characteristics were analyzed using ATR FT-IR, XPS, SEM, XRD, and contact angle measurements. Furthermore, the in vitro biomineralization potential was assessed employing the Taguchi method, while the in vitro release of clindamycin phosphate was examined through UV-Vis spectrophotometry. The CS/HA-CLY membranes exhibited improved wettability, drug release behavior, and biomineralization ability compared to neat CS. These results suggest that the developed composite membranes could successfully combine antibacterial efficacy and biocompatibility, supporting their potential as multifunctional biomaterials for preventing implant-related infections while promoting tissue integration. These findings provide a promising basis for further biological assays and in vitro evaluation.

Aim This study evaluated the therapeutic efficacy of a carbohydrate-ester-based dual antibiotic formulation (gentamicin/clindamycin; CC-G/C) 1 designed for local, sustained-release treatment of bone and joint infections. A porcine model of acute osteosynthesis-associated osteomyelitis (OAO) undergoing a debridement, antibiotics and implant retention (DAIR) procedure - without administration of systemic antibiotics – was used. Method A locking compression plate with four screws was placed medially on the proximal right tibia of 16 pigs (no fracture) and inoculated with Staphylococcus aureus S54F9 (10 4 CFU). On day three, histology and microbiology confirmed the development of extensive purulent osteomyelitis and soft tissue infection in three pigs, which served as primary infection controls. The remaining 13 pigs underwent a DAIR procedure with purulent drainage, extensive soft tissue debridement, saline irrigation, and implant retention. In nine pigs, 5 mL of CC-G/C was injected around the plate and screws, and into surrounding soft tissue via 23- or 21-gauge needles. Four pigs that underwent DAIR without antibiotics treatment served as controls. Among the nine pigs receiving CC-G/C, three received CC-G/C primarily in the macroscopically infected areas. A more infiltrative approach was applied in the following six pigs, with deeper CC-G/C injections and placement between plate and bone where possible. No systemic antibiotics were administered in any of the pigs. Tibial radiographs were obtained 11 days after the DAIR, and bone, soft tissue, and implants were collected for microbiology and histopathology. Results Purulent osteomyelitis and sequestration were observed in control animals on day 11. The pilot group displayed a reduction of Staphylococcus aureus count compared to untreated controls. The infiltrative treatment approach improved therapeutic outcomes, with three out of six pigs achieving complete eradication of infection in bone, soft tissue and on implants. In the remaining three pigs, only one bone, soft tissue, or implant sample tested positive for Staphylococcus aureus . Histopathology demonstrated tissue biocompatibility of CC-G/C, apparent decreased neutrophil infiltration and reduced pathological bone area compared to controls. Radiographs showed reduced periosteal and endosteal proliferation, and less trabecular and cortical osteolysis. Conclusions Surgical debridement combined with local CC-G/C administration demonstrated strong therapeutic potential in a porcine OAO model without systemic antibiotics, highlighting its potential in DAIR strategies. The thin-needle injectability of CC-G/C enabled precise, tissue-compliant delivery and adequate dose coverage, supporting its use as a targeted and potent antibiotic delivery system. CC-G/C system is a promising adjunct to surgical debridement, offering potential for improved treatment outcomes in DAIR procedures.

Aim Chronic osteomyelitis continues to present major challenges in orthopedic and trauma surgery. Surgical excision of infected bone creates a defect that must be managed effectively to prevent reinfection. Due to limited penetration of systemic antibiotics into devascularized bone, local antibiotic delivery has gained importance as a therapeutic adjunct. This prospective study evaluates the efficacy of a single-stage surgical protocol using a bioabsorbable calcium sulfate/hydroxyapatite composite loaded with gentamicin. Results are also compared to a previous cohort from the same institution (Niemann et al.). Method Thirty-six patients with chronic osteomyelitis (Cierny-Mader types III and IV) were treated in a single-stage procedure involving radical debridement, deep tissue sampling, local and systemic antibiotic administration, and immediate soft tissue closure. The diagnosis was confirmed through strict clinical and microbiological criteria. The average follow-up period was 3.05 years (range: 2.2–6.4 years). Results Three patients experienced recurrence, corresponding to a 94.2% infection-free rate. All recurrences occurred within the first postoperative year. No significant associations were found between recurrence and physiological classification, infection etiology, pathogen type, or preoperative pseudarthrosis. Gentamicin-resistant pathogens were significantly more common in polymicrobial infections, but resistance did not correlate with increased recurrence. Compared to the prior cohort studied by Niemann et al., the need for revision surgery decreased significantly—from 10 out of 22 patients to 4 out of 36 in the current group—representing a 75% reduction. Conclusion The use of an absorbable, antibiotic-loaded calcium sulfate/hydroxyapatite composite appears to be a safe and effective option for treating chronic osteomyelitis. Complete resorption of the material reduces the risk of foreign body retention after antibiotic delivery. The single-stage surgical approach, in conjunction with local high-dose antibiotic therapy, has shown durable outcomes over midterm follow-up. The improvement in revision rates compared to earlier results may be attributed to enhanced soft tissue management and growing experience with the bio-composite material. Continued research is necessary to evaluate long-term outcomes and to better understand patient-specific prognostic factors.

Our review study addresses chronic periodontitis and its potential complications in the distal segments of the intestine and rectum. Subgingival colonization by gram-negative anaerobic bacteria such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens, and Fusobacterium nucleatum may, through haematogenous dissemination into non-oral tissues and organs, cause severe systemic diseases. In connection with colorectal carcinoma, the third most frequently diagnosed malignant tumor, special attention has been focused on the anaerobic rod Fusobacterium nucleatum, one of the key periodontal pathogens involved in periodontal pocket infections. A growing amount of direct and indirect evidence supports its role in the development, progression, and persistence of colorectal carcinoma in the distal colon and rectum. F. nucleatum possesses numerous virulence factors that underlie its remarkable infectious potential, not only within the oral cavity but also in the colonic environment, where they facilitate its integration into the dysbiotic microbiome and directly contribute to carcinogenesis in this region. Disruption of the physiological microbiota and colonization by F. nucleatum are now considered major drivers of malignant tumorigenesis in the distal colon. Several studies confirm the oral origin of F. nucleatum and its potential haematogenous spread into the intestinal microenvironment. Eradication of F. nucleatum from the colon is regarded as a crucial factor in achieving successful treatment outcomes for colorectal cancer (CRC). However, systemic administration of broad spectrum antibiotics adversely affects the composition of the normal gut microbiome, leading to microbial imbalance. For this reason, the elimination of F. nucleatum in the colon and rectum relies on a whole range of antibacterial agents that minimally disrupt the gut microbiota. Our eradication strategy for F. nucleatum emphasizes close cooperation between dentists or periodontologists and gastroenterologists or oncologists, targeting high-risk populations: patients with IBD, colorectal adenomas ≥1 cm, multiple polyps, or first-degree relatives with CRC diagnosed before age 60. These at risk patients undergo dental evaluation for periodontitis and gingivitis by collaborating dentists. Identified cases are treated using localized, comprehensive, and early eradication strategies targeting F. nucleatum and other periodontal pathogens within the periodontal pocket microenvironment. The primary objective of early interdisciplinary cooperation is to detect early stages of periodontitis with periodontal pocket depths of up to 4 mm. In such early forms of periodontitis, elimination of infection can be achieved through local approaches including scaling, deep scaling, and curettage, combined with the application of antibacterial solutions, varnishes, antimicrobial impregnated fibers, and, where appropriate, the use of periodontal lasers.

Development and modeling of Silk Sericin Gentamicin microparticles as a drug delivery system.

associated with periodontal diseases, making it a natural way to treat such conditions.In India, it is known as Haldi, and the British used it as a curry spice.Turmeric contains a variety of phytoconstituents, including proteins (6.3%), fat (5.1%), minerals (3.5%), and a diarylheptanoid coloring substance (5%) referred to as curcuminoids.Rhizomes contain 1% free arabinose, 12% fructose, 2% glucose, and 30-60 m long zingiber starch grains.Curcumin IntroductIonPeriodontitis is a bacterial biofilm-induced inflammatory disease.The majority of biocidal events in periodontal tissues are brought on by the host's immune-inflammatory response to bacteria in plaque, which triggers destructive processes. 1,2Mechanical therapy, chemotherapy, and systemic antibiotic administration are some of the treatment options. 3,4Scaling, root planing, and curettage are all examples of traditional mechanical therapy, but they cannot eliminate irritants completely in inaccessible areas. 5,6hemotherapeutic drugs have been utilized as an adjuvant to mechanical therapy to improve the efficacy of conventional therapy.However, due to drawbacks in the use of systemic antibiotics-such as the development of resistance and side effects-the local drug delivery system has gained popularity over time. 6Mechanical therapy combined with local delivery systems reduces microbes and improves clinical parameters.Herbal medicines have been used for a long time.People trust their use in healthcare because of their biocompatibility, reduced toxicity, sustainability, and synergistic effects of their constituents.Common herbal products used in dentistry include neem, clove, cinnamon, turmeric, and Aloe vera, among which turmeric is a dietary spice and curcumin is its most active ingredient. 7It can help to eliminate inflammation and infection 1-

Antimicrobial resistance (AMR) is a global health threat for people and animals, including wildlife. The overuse and misuse of antimicrobials continues to fuel the spread of AMR. We performed a retrospective analysis of systemic antibiotic administration in fire‐affected koalas admitted to two wildlife treatment facilities during the catastrophic Australian wildfires in 2019–2020, to assess the practice of antimicrobial stewardship during a wildlife emergency. Triage and treatment records were obtained for fire‐affected koalas (n = 355) admitted to two facilities during the wildfires. Analyses showed that 40.3% of koalas at Facility A and 35.0% of koalas at Facility B received systemic antibiotics. The majority of antibiotics (63.9%, comprising multiple types of beta‐lactams) administered to koalas at Facility A were prophylactic treatments in koalas with noninfected moderate to severe cutaneous burn wounds. The majority of antibiotics (75.0%, comprising chloramphenicol and enrofloxacin) administered to koalas at Facility B were chlamydial disease treatments. Overall, 29.4% of all antibiotic treatments (predominantly beta‐lactams and enrofloxacin) were administered for recorded clinical infections. Where koala‐specific guidelines and protocols for treating burn wounds were not available, there was an overuse of systemic antibiotics and frequently sub‐optimal antibiotic stewardship in burnt koalas during the 2019–2020 wildfire emergency response. Best practice antibiotic prescribing was also not always feasible due to a shortage of first‐choice antibiotics (e.g., injectable chloramphenicol for chlamydial disease). This study highlights the importance of preparedness for future wildfire events and identifies a need for equipping veterinarians with guidelines for treating fire‐affected koalas during emergency situations. Additional education, guidance and resources are required to enable appropriate antimicrobial stewardship by responding veterinarians during wildlife emergencies.

Urinary tract infections (UTIs) are highly prevalent among women and those assigned female at birth, and frequently necessitate the administration of systemic antibiotics, which contributes to the antibiotic resistance crisis due to overuse and suboptimal patient adherence. This study introduces an innovative 3D-printed stent designed specifically for the localized treatment of UTIs, aiming at reducing systemic drug exposure and lowering recurrence rates. Tailored for the female urethra, the stent consists of a laponite-alginate hydrogel scaffold integrated with cannabidiol (CBD)-loaded PLGA microparticles to facilitate controlled drug release. A Design of Experiments (DoE) approach was utilized to optimize printing parameters, ensuring structural integrity and printability. CBD, known for its analgesic and antimicrobial properties, was added as therapeutic agent. The composite system exhibited prolonged antimicrobial activity against both Gram-positive and Gram-negative bacteria. This localized strategy has the potential to enhance therapeutic effects while reducing the need for systemic administration, which may, in turn, help limit associated side effects and improve patient adherence. The integration of 3D printing technology and controlled drug release signifies a substantial advancement towards more effective and personalized interventions for UTI management.

Rationale & ObjectiveIt is unknown whether administration of prophylactic systemic antibiotics immediately before tunneled catheter insertion can prevent early hemodialysis catheter-related bloodstream infections (HDCRBSI). We aimed to estimate the effect of systemic prophylactic antibiotics on early HDCRBSI.Study DesignAn observational secondary analysis using data from the nationwide REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial.Setting & ParticipantsAdults with an incident hemodialysis catheter inserted in one of 37 Australian nephrology services from December 2016 to March 2020.ExposureService-wide policy of systemic prophylactic antibiotic use before tunneled catheter insertion determined by response to a prestudy survey.OutcomeHDCRBSI within 14 days of catheter insertion, independently adjudicated by a blinded panel using modified Infectious Diseases Society of America criteria.Analytical ApproachMultilevel logistic regression to compare outcomes among antibiotic-using and nonusing services.ResultsSix services (900 patients) used prophylactic antibiotics, and 23 services (3,702 patients) did not. Among the 1,196 tunneled catheters that were inserted in antibiotic-using services, 4 (0.3%) had HDCRBSI and another 10 (0.8%) had infectious removal within 14 days of insertion. Among the 5,027 tunneled catheters inserted in nonantibiotic-using services, 40 (0.8%) had HDCRBSI and another 41 (0.8%) had infectious removal within 14 days. The odds of early HDCRBSI were not significantly different between antibiotic-using and nonusing services in the unadjusted (OR, 0.42; 95% CI, 0.15-1.17) or adjusted models (adjusted OR, 0.59; 95% CI, 0.20-1.80).LimitationsProphylactic systemic antibiotic use was determined at a service level and was not randomly assigned to individuals.ConclusionsIn Australia, less than 1% of tunneled catheters had confirmed HDCRBSI within 14 days of insertion. Routine administration of prophylactic antibiotics before insertion of tunneled cuffed catheters was not associated with a reduced occurrence of early HDCRBSI within 14 days.

Cutibacterium acnes is a commensal skin and mucosal bacterium that causes CSF shunt infections. The traditional management of C. acnes shunt infections aligns with the treatment of infections caused by more serious bacteria and consists of shunt removal, external ventricular drainage, and systemic antibiotic administration. Given the relatively benign nature of C. acnes, such extensive measures may not be required for infection eradication. This study compares the efficacy of a one-stage surgical shunt replacement, omitting the interim external ventricular drainage phase, with the traditional two-stage approach. A retrospective data analysis was conducted on the medical records of patients diagnosed with C. acnes shunt infection between 1997 and 2023. Clinical and diagnostic data were collected. Forty-three patients with C. acnes shunt infection were identified. Of these patients, 26 underwent traditional two-stage shunt replacement with intervening external ventricular drainage, and 14 underwent one-stage shunt replacement without an interim external drainage period. Nine patients underwent endoscopic third ventriculostomy in an attempt to achieve shunt independence. C. acnes shunt infection was cleared in all patients with no recurrence at median follow-up periods of 7.08 years and 9.05 years for the one-stage and two-stage replacement groups, respectively. The findings indicate that one-stage shunt replacement surgery without intervening externalization is an effective treatment option for C. acnes shunt infections. In addition to eliminating the need for multiple surgical interventions, this approach shortens hospital stays, thereby reducing healthcare costs and minimizing patients' exposure to hospital-associated risks. This study supports a reevaluation of current guidelines for treating shunt infections, advocating for more flexible, patient-centered approaches that consider the pathogenicity of offending organisms such as C. acnes.

ABSTRACTBackground:Endo-perio lesions present a complex interplay between endodontic and periodontal infections, often leading to treatment challenges. The microbial flora associated with these lesions includes a diverse range of pathogenic bacteria contributing to disease progression. Evaluating changes in microbiological flora before and after treatment is crucial for assessing the efficacy of therapeutic interventions.Materials and Methods:A total of 30 patients diagnosed with endo-perio lesions were included in this study. Microbiological samples were collected from the lesion sites before treatment and after six weeks of therapy. The treatment involved root canal therapy combined with periodontal debridement and systemic antibiotic administration. Microbial analysis was performed using culture methods and polymerase chain reaction (PCR) to identify key bacterial species, including Porphyromonas gingivalis, Fusobacterium nucleatum, and Enterococcus faecalis. Statistical analysis was conducted using paired t tests to assess microbial reduction.Results:Before treatment, P. gingivalis was detected in 85% of cases, F. nucleatum in 75%, and E. faecalis in 60%. After treatment, the prevalence of these bacteria reduced significantly, with P. gingivalis detected in 30% of cases, F. nucleatum in 25%, and E. faecalis in 15% (P < 0.05). The reduction in bacterial load correlated with improved clinical parameters, including decreased pocket depth and reduced pain scores.Conclusion:The findings indicate that combined endodontic and periodontal therapy significantly reduces pathogenic microbial load in endo-perio lesions, leading to clinical improvement. Effective microbial control is essential for successful management, emphasizing the need for comprehensive treatment approaches.

Sepsis and Common Infections in Interventional Radiology.

Lessons from practice Neisseria meningitidis : an uncommon cause of conjunctivitisClinical record A 28-year-old man developed a painful left eye with purulent discharge two weeks after recovering from coronavirus disease 2019.His medical history included multiple sclerosis (untreated) and myopia (managed with contact lenses).Reduced vision prompted emergency department review and slit lamp examination demonstrated diffuse conjunctival erythema without keratitis.Visual acuity was reassuringly intact in the left eye (6/9-1 with glasses, 6/6-2 pinhole) and right eye (6/6-2 with glasses, 6/6-1 pinhole).He was discharged with a diagnosis of bacterial conjunctivitis and prescribed topical chloramphenicol for seven days.Unexpectedly, cultures from an eye swab returned predominant growth of Neisseria meningitidis.The patient was recalled and, following Australian Therapeutic Guidelines, was treated as for invasive meningococcal disease. 1 Intravenous ciprofloxacin 400 mg three times a day was prescribed considering history of ceftriaxone anaphylaxis.High risk contacts were provided rifampicin prophylaxis.The patient was systemically well with no clinical signs of meningism.Blood cultures collected before administration of systemic antibiotics were negative.After receiving five days of ciprofloxacin, the patient was discharged.It was unclear whether he had been previously vaccinated for meningococcal disease.

This review aims to summarise recent literature in the past decade, focusing on new insights, management strategies, and technique modifications for intraocular foreign body (IOFB) cases. We discuss the latest epidemiological data, diagnostic assessments, and challenging presentations of IOFB. Imaging, particularly non-contrast helical computed tomography with thin cuts, is a valuable diagnostic adjunct. The administration of perioperative prophylactic systemic and intravitreal antibiotics may be useful in reducing infective endophthalmitis risk. We recommend same stage IOFB removal with primary repair within 24 hours whenever feasible. Furthermore, the latest updates on surgical planning, techniques, and instrumentation for IOFB removal, including crystalline lens management, IOFB extraction routes, and intraoperative adjuncts such as perfluorocarbon liquid, cohesive viscoelastic, and mitomycin-C are described. Various IOFB removal techniques including magnet-based, scaffold, suture-based, aspiration and bimanual methods, specialised and innovative instruments are also discussed. This review compiles the most recent advancements and techniques, offering a comprehensive update on the clinical management and surgical removal of IOFB.

Pyogenic ventriculitis is characterized by ependymal inflammation with the presence of pus in the ventricles. We present a 63-year-old male who sustained head trauma due to a motor vehicle accident and was primarily admitted to another hospital. Since his symptoms persisted despite the first 3 CT scans being insignificant, he was referred to our hospital on day 4. CSF analysis was typical of bacterial meningitis, but CSF and blood cultures were negative. CT head revealed normal findings, except for a minimally displaced right maxillary fracture with hemosinus. Poor progress in the sensorium impelled us to investigate further with a CSF PCR which detected Klebsiella pneumoniae and an MRI Brain with contrast, which revealed features of ventriculo-meningitis. Administration of long-term systemic antibiotics resulted in an early recovery. Streptococcus pneumoniae is the most commonly implicated pathogen in head trauma-related ventriculitis. Our case, being a Klebsiella ventriculo-meningitis, is a rare occurrence in head trauma. We would like to underscore the point that when clinical presentation in head trauma is subtle and non-specific, with minimal microbiological and imaging evidence, an early MRI Brain with contrast coupled with a CSF PCR expedites the diagnosis of a rare cause of ventriculo-meningitis, which has high mortality. Keywords: Computerised tomography; PCR (polymerase chain reaction); Ventriculo-meningitis; Magnetic resonance imaging; Klebsiella; Head trauma; Cerebrospinal fluid