Systemic Broad-spectrum Antibiotics Research Articles

Risk of Superinfection in Peri-implantitis After Systemic Broad Spectrum Antibiotics.

Peri-implant disease has developed over the last few years as a complication that is often difficult to resolve. The disease process is mainly attributed to bacterial infection. Proposed combined therapies use broad-spectrum antibiotics to halt its progression. A major associated risk is the undetected development of superinfections that are difficult to eradicate. A group of healthy individuals with advanced peri-implantitis (PI) were referred for evaluation due to severe, rapidly progressive bone loss. Previous nonsurgical and empiric antibiotic therapy had been rendered. Culture and polymerase chain reaction-based identification were performed for PI lesions, healthy implants, and saliva. Clinical and radiographic examinations revealed peri-implant bleeding on probing, deep pockets, and severe radiographic bone loss with absence of lamina dura. A number of superinfecting agents were identified, such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Candida albicans, and Epstein-Barr virus (EBV). EBV is significantly more prevalent at peri-implantitis sites than at healthy implants and in saliva. Specific systemic antimicrobial therapy and nonsurgical or surgical debridement may eradicate some opportunistic pathogens, but follow-up tests should be performed to identify potential emerging pathogenic microbiota, such as C albicans and enteric rods, at peri-implant sites. Antifungal and antiviral therapy may be needed. Due to the extent and severity of tissue loss, some implants were removed. Peri-implant superinfections are a major risk associated with broad-spectrum antibiotics in immunocompetent individuals. Lack of follow-up and antibiotic susceptibility testing and indiscriminate empiric treatment regimens may lead to ongoing microbial challenge that exacerbates and maintains the disease progression. Personalized periodontal supportive therapy could prevent risks by sustaining a healthy microbial ecologic balance, reducing specific pathogen proportions, maintaining optimal plaque control, and detecting early signs of inflammation.

Culture-Positive Endophthalmitis After Open Globe Injuries With and Without Retained Intraocular Foreign Bodies.

To report the visual and anatomical outcomes and microbiologic spectrum of culture-positive endophthalmitis in open globe injuries (OGIs) with or without intraocular foreign bodies (IOFBs). A retrospective, interventional case series of OGIs (n = 718) treated between 2004 and 2015. Patients underwent a management protocol for OGI, including systemic broad-spectrum antibiotics, on presentation. Culture-positive cases of endophthalmitis after open globe repair occurred in 2.1% of eyes (n = 15 of 718 eyes); two eyes had evidence of endophthalmitis on presentation. The most common organism was Staphylococcus species (five of 17 eyes). An IOFB was present in 6.8% of eyes (n = 49 of 718 eyes). All of these eyes received prophylactic intravitreal antimicrobials. In eyes with IOFB, the rate of culture-positive endophthalmitis after initial globe repair was 8.1% (n = 4 of 49 eyes) versus 1.6% (n = 11 of 669 eyes) in eyes without IOFB (P < .01). Culture-positive endophthalmitis was identified after OGIs more often in eyes with a concurrent IOFB. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:632-637.].

Microbiota Disruption Induced by Early Use of Broad-Spectrum Antibiotics Is an Independent Risk Factor of Outcome after Allogeneic Stem Cell Transplantation

In allogeneic stem cell transplantation (ASCT), systemic broad-spectrum antibiotics are frequently used for treatment of infectious complications, but their effect on microbiota composition is still poorly understood. This retrospective analysis of 621 patients who underwent ASCT at the University Medical Center of Regensburg and Memorial Sloan Kettering Cancer Center in New York assessed the impact of timing of peritransplant antibiotic treatment on intestinal microbiota composition as well as transplant-related mortality (TRM) and overall survival. Early exposure to antibiotics was associated with lower urinary 3-indoxyl sulfate levels (P < .001) and a decrease in fecal abundance of commensal Clostridiales (P = .03) compared with late antibiotic treatment, which was particularly significant (P = .005) for Clostridium cluster XIVa in the Regensburg group. Earlier antibiotic treatment before ASCT was further associated with a higher TRM (34%, 79/236) compared with post-ASCT (21%, 62/297, P = .001) or no antibiotics (7%, 6/88, P < .001). Timing of antibiotic treatment was the dominant independent risk factor for TRM (HR, 2.0; P ≤ .001) in multivariate analysis besides increase age (HR, 2.15; P = .004), reduced Karnofsky performance status (HR, 1.47; P = .03), and female donor–male recipient sex combination (HR, 1.56; P = .02) A competing risk analysis revealed the independent effect of early initiation of antibiotics on graft-versus-host disease–related TRM (P = .004) in contrast to infection-related TRM and relapse (not significant). The poor outcome associated with early administration of antibiotic therapy that is active against commensal organisms, and specifically the possibly protective Clostridiales, calls for the use of Clostridiales-sparing antibiotics and rapid restoration of microbiota diversity after cessation of antibiotic treatment.

Ludwig's Angina: Report of 40 Cases and Review of Current Concepts in Emergency Management in a Rural Tertiary Facility Teaching Hospital

ABSTRACT Objective To review the current protocols and assess their efficacy in the emergency management of cases presenting with Ludwig's angina. Materials and methods A retrospective study of patients diagnosed with Ludwig's angina, admitted and treated in our institution between November 2007 and December 2012. Results There were 40 cases with 24 males (60%) and 16 females (40%), ages ranged between 16 and 80 years. Duration of symptoms was between 3 days and 2 weeks. The most common cause was dental infections seen in 23 cases (57.5%), one of them was a pregnant lady. Six were due to habitual tooth pricking with a broom stick (15%). In 3 patients it was due to submandibular duct stenosis secondary to calculi (7.5%). Five patients had diabetes as underlying disease (12.5%). Facial trauma contributed in 2 patients (5%) and in 1 patient it was due to carcinoma buccal mucosa (2.5%). All the patients were treated with systemic broad spectrum antibiotics, intravenous fluids, and analgesics. Twenty patients (50%) underwent tracheostomy with surgical decompression through small incisions under local/ general anesthesia. Ten patients (25%) were subjected to incision and drainage with subsequent removal of the diseased teeth. Ten patients (25%) were managed conservatively with antibiotics, analgesics, and under close supervision for airway compromise. There were no complications recorded and no mortality. Conclusion Ludwig's angina is a life-threatening surgical emergency. Early diagnosis and immediate surgical intervention can save lives. The appropriate use of parenteral antibiotics complemented with airway protection and surgical decompression remains the standard treatment protocol in advanced cases of Ludwig's angina. How to cite this article Ambikavathy M, Kumar S. Ludwig's Angina: Report of 40 Cases and Review of Current Concepts in Emergency Management in a Rural Tertiary Facility Teaching Hospital. Int J Head Neck Surg 2017;8(1):11-14.

WITHDRAWN: Interventions for ear discharge associated with grommets (ventilation tubes).

The insertion of grommets (also known as ventilation or tympanostomy tubes) is one of the most common surgical procedures performed on children. Postoperative otorrhoea (discharge) is the most common complication with a reported incidence ranging from 10% to 50%. In the UK, many ENT surgeons treat with topical antibiotics/steroid combinations, but general practitioners, mainly through fears of ototoxicity, are unlikely to prescribe these and choose systemic broad-spectrum antibiotics. 1. To identify the most effective non-surgical management of discharge from ears with grommets in place.2. To identify the risks of non-surgical management for this condition (e.g. ototoxicity), and to set benefits of treatment against these risks. We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1966 to 2005) and EMBASE (1974 to 2005). We also searched the CINAHL, AMED, LILACS, ISI WEB OF KNOWLEDGE, ISI PROCEEDINGS, mRCT, NNR, ZETOC, KOREAMED, CSA, MEDCARIB, INDMED and SAMED databases. The date of the last search was February 2005. Randomised controlled trials of adults or children, with any type of grommet and an ear with discharge were included. The trials compared treatment with placebo or one treatment with another. The primary outcome measure was the duration of the discharge. The trials were selected independently according to the above criteria by the four reviewers. Differences in opinion over the inclusion of studies were resolved by discussion. The studies were graded using the CASP critical appraisal tool. Analyses were based on the presence of discharge seven days from the onset of treatment. There was very little good quality evidence. Four studies were included, all of them investigating different interventions and therefore a meta-analysis was not possible.Only one study demonstrated a significant difference. Oral amoxicillin clavulanate was compared to placebo in 79 patients. The odds of having a discharge persisting eight days after starting treatment was 0.19 (95% CI 0.07 to 0.49) . The number needed to treat to achieve that benefit is 2.5. Participants in both arms of this study also received daily aural toilet. The results will therefore not be applicable to most settings including primary care. No significant benefit was shown in the two studies investigating steroids (oral prednisolone with oral amoxicillin clavulanate and topical dexamethasone with topical ciprofloxacin ear drops), or the one study comparing an antibiotic-steroid combination (Otosporin®) drops versus spray (Otomize®) (although more patients preferred the spray form). The authors of this review have been unable to identify the most effective intervention or to assess the associated risks. Research is urgently needed into the effectiveness of oral versus topical antibiotics in this group of patients. Clinicians considering antibiotic treatment need to balance any potential benefit against the risks of side effects and antibiotic resistance.

Comparison of Boric Acid and Combination Drug of Polymyxin, Neomycin and Hydrocortisone (polymyxin NH) in the Treatment of Acute Otitis Externa.

Acute otitis externa is an inflammation of the external auditory canal known as "swimmer's ear". Direct costs including medical treatment, painkillers, antibiotics, steroids or both and indirect costs are also remarkable. The aim of this study was to compare the effect of boric acid and polymyxin, neomycin and hydrocortisone composition in the treatment of acute otitis externa. This randomized clinical trial was carried out on 80 patients aged more than 17-year-old who were referred to Kashani hospital clinic with a diagnosis of acute otitis externa by otolaryngologist. The patients were randomly allocated to two groups (A: Boric acid and B: polymyxin NH ear drops) and Painkiller was prescribed and administered orally for all patients and in the presence of fever, cellulitis around the ears and neck adenopathy, broad-spectrum systemic antibiotics were used besides topical treatment. Symptoms of patients who were evaluated by a physician includes pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching. In addition, pain was evaluated in patients and was recorded by Macgill Pain Questionnaire, in the first, third, seventh and tenth days. Results showed that itching on third day (p=0.007) and swelling of the ear canal in the examination of the third day (p=0.006) and the seventh day (p=0.001) in the polymyxin NH group was more than those of boric acid group. Overall mean pain based on McGill questionnaire was 11.10±1.49 in boric acid group in the examination on the first day and was 4.05±0.22 in the examination on the tenth day and in the polymyxin NH group, it was 10.9±0.99 on the first day and 4.20±0.40 on the tenth day. In both groups, pain relief was the same and there was no significant difference between two groups (p=0.075). The findings of this study showed slight differences in the effectiveness of the boric acid drug and combination of polymyxin, neomycin and hydrocortisone in the treatment of patients with acute otitis externa that is of clinical significance.

Molecular detection of bovine coronavirus in a diarrhea outbreak in pasture-feeding Nellore steers in southern Brazil.

Worldwide diarrhea outbreaks in cattle herds are more frequently detected in calves being that diarrhea outbreaks in adult cattle are not common. Winter dysentery (WD) is a bovine coronavirus (BCoV) enteric infection that is more reported in Northern hemisphere. Seasonal outbreaks of WD in adult cattle occur mainly in dairy cows. WD has not been described in beef cattle herds of tropical countries. This study describes the molecular detection of BCoV in a diarrhea outbreak in beef cattle steers (Nellore) raised on pasture in Parana, southern Brazil. During the outbreak, the farm had about 600 fattening steers. Watery and bloody diarrhea unresponsive to systemic broad-spectrum antibiotic therapy reveals a morbidity rate of approximately 15 %. The BCoV N gene was identified in 42.9 % (6/14) of the diarrheic fecal samples evaluated by semi-nested polymerase chain reaction (SN-PCR) technique. Other enteric microorganisms occasionally identified in adult cattle and evaluated in this study such as bovine groups A, B, and C rotavirus, bovine viral diarrhea virus, bovine torovirus, aichivirus B, and Eimeria sp. were not identified in the fecal samples. To the best knowledge of the authors, this is the first description of the BCoV diagnosis in fecal samples collected in a diarrhea outbreak in adult beef cattle grazing in the grass in a tropical country.

Clinical analysis of 23-gauge vitrectomy for the treatment of acute endophthalmitis after cataract surgery.

We performed a retrospective study to evaluate the surgical efficacy and timing of 23-G vitrectomy for acute endophthalmitis following cataract surgery, and to determine when silicone oil tamponade and intraocular lens (IOL) removal are indicated during vitrectomy for endophthalmitis. We enrolled 21 patients (21 eyes) diagnosed with acute endophthalmitis following cataract surgery who underwent endoscope-assisted 23-G vitrectomy using a wide-angle noncontact lens. Silicone oil tamponade was performed when retinal tear or detachment occurred. The IOL was not removed during primary vitrectomy. Postoperative systemic broad-spectrum antibiotics were used. All infections were controlled by treatment. Best-corrected visual acuity was &gt;0.05 in 14 patients (66.7%) after treatment, which was significantly higher than that before treatment (2/21, 9.5%). Two patients experienced retinal detachment at 10 and 14 days after primary vitrectomy; the IOL was removed during secondary surgery, and silicone oil tamponade was performed. One patient experienced endophthalmitis recurrence 2 months after vitrectomy; secondary surgery was performed to remove the peripheral vitreous body, the pars plana of the ciliary body, and the IOL and capsule. Vitrectomy should be performed when acute endophthalmitis is diagnosed following cataract surgery. Silicone oil tamponade should be performed only when retinal break or detachment occurs. The IOL does not necessarily require removal.

Pulmonary Hemorrhage Secondary to Disseminated Strongyloidiasis in a Patient with Systemic Lupus Erythematosus

Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate. Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently developed a characteristic purpuric skin eruption and septic shock and died two days later of refractory hypoxemia caused by massive pulmonary bleeding. The postmortem examination reports filariform larvae of S. stercolaris in lung, skin, and other organs. Conclusion. This case highlights the importance of considering disseminated strongyloidiasis in the differential diagnosis of diffuse alveolar hemorrhage in systemic lupus erythematosus, and screening for S. stercolaris infection before initiation of immunosuppressive therapy should be considered, especially in endemic areas. Disseminated strongyloidiasis has a high mortality rate, explained in part by absence of clinical suspicion.

Gradenigo syndrome: an unexpected otitis complication

Introduction : Gradenigo syndrome (also known as apical petrositis) is a clinical triad of otitis media, trigeminal neuralgia and ipsilateral abducens nerve palsy. In the era of antibiotic therapy, it is an exceptional but potentially life threatening complication of acute otitis media, requiring prompt diagnosis and treatment. Case report : A seven-year-old girl with previous history of otitis, presented with left ear pain, headache, diplopia and fever. Diagnosis of Gradenigo syndrome was established and she was treated with systemic broad-spectrum antibiotics and myringotomy with timpanostomy tube placement. Clinical outcome was favourable. Conclusion : This case documents therapeutic success and total recovery with a conservative approach in an immunocompe

A Case of Chronic Osteomyelitis of the Orbit

Purpose: To report a case of chronic osteomyelitis of the orbit. Case summary: A 61-year-old woman visited the ophthalmology clinic with a 3-month history of right periorbital swelling and pain. She had a history of ondontitis treated with oral antibiotics three months previously. A hard, tender, swollen mass was palpated near the right lower eyelid extending to the floor of the right orbit. Otherwise, there were no other clinically-specific ocular signs. Orbital computed tomography and bone scan findings suggested right periorbital soft tissue inflammation with underlying osteomyelitis of maxillar and zygomatic bones involving the inferior and lateral orbital walls. The patient was admitted and treated with broad spectrum systemic antibiotics. After 7 days, periorbital soft tissue swelling and pain were improved, but the size of the hard mass was unchanged. Seven days after admission, incision and drainage of the periorbital hard mass near the lower eyelid and debridement of the necrotic and pyogenic tissue were performed. Histologic examination showed chronic granulomatous inflammation and bony necrosis of the mass. The patient was discharged after receiving systemic antibiotics for 7 more days. At the 6-month follow-up, no recurrence or abnormal findings in the right periorbital region were observed. Conclusions: Chronic orbital osteomyelitis should be treated with combined systemic antibiotics and surgical intervention. J Korean Ophthalmol Soc 2014;55(6):902-907

CLINICAL CHALLENGE: SYSTEMIC RHIZOPUS MICROSPORUS INFECTION WITH RENAL CAVITATION IN A GREY SEAL (HALICHOERUS GRYPUS)

A 22-yr-old, intact female grey seal (Halichoerus grypus) (wt: 155 kg) had limited prior medical history other than persistent perionychitis of the right pedal flipper. Four years before the current presentation, this problem had been resolved completely by skeletal amputation of the right pedal digit 3 distal phalanx. During that same year, and progressive over the following 3 yr, the seal developed cataracts and keratopathy including corneal vascularization, pigmentation, and edema. It was elected to perform cataract removal, corneal debridement, and placement of subconjunctival cyclosporine implants (Lux Biosciences Inc., Jersey City, New Jersey 07302, USA; lot# 47614, 0.75 inch). Postoperative treatment (Fig. 1) was initiated with systemic broadspectrum antibiotics, anti-inflammatory and antifungal medications, gastroprotectants, and topical ophthalmic care that included antibiotics and anti-inflammatory medications. After 6 mo of treatment, no substantial improvement to the seal’s ophthalmic status was noted. The corneal hyperpigmentation OU had recurred and a stromal abscess OD had developed. Additionally, the seal presented with non-

Fidaxomicin versus Conventional Antimicrobial Therapy in 59 Recipients of Solid Organ and Hematopoietic Stem Cell Transplantation with Clostridium difficile-Associated Diarrhea

The feasibility of fidaxomicin versus vancomycin and metronidazole (conventional therapy) was assessed in 59 transplant recipients with 61 episodes of Clostridium difficile-associated diarrhea (CDAD). Overall clinical cure was achieved in 86% of episodes, and in 7% of episodes, infection recurred. Fidaxomicin was well tolerated. Clinical cures were not significantly different compared with conventional therapy (67% versus 89%, respectively; P = 0.06). Univariate analysis of predictors for lack of clinical cure included continued use of broad-spectrum systemic antibiotics (P = 0.026) and prior diagnosis of CDAD (95% confidence interval, 1.113 to 19.569; odds ratio, 4.667; P = 0.041). New-onset vancomycin-resistant Enterococcus (VRE) colonization was not noted after fidaxomicin therapy alone. However, this occurred in 10 of 28 patients (36%) following conventional therapy, and 2 of 3 patients with subsequent bacteremia died.

Feasibility of percutaneous needle aspiration for the treatment of breast abscesses

Objective: To assess the feasibility and effectiveness of percutaneous needle aspiration under local anesthesia for the treatment of acute breast abscesses in the outpatient breast clinic. Design: A retrospective study of forty three female patients with acute breast abscesses. Setting: Breast clinic in Al Jamhoory teaching hospital in Mosul between February 2004 to February 2007. Methods: Forty three patients with acute breast abscesses were studied. Special enquiries were made regarding lactation, symptomatology and sites of abscesses. All patients had preliminary breast ultrasound (U/S) examination. In the breast clinic, percutaneous needle aspiration of pus under local anesthesia was done followed by systemic antibiotic therapy. Repeated aspiration was carried out later when deemed necessary and follow up by (U/S) was conducted. Results: Forty three patients aged between 16-75 years (mean 37 years) having a provisional diagnosis of acute breast abscesses. All patients presented with a palpable tender mass, of which 4 patients had retro-areolar abscesses. All patients had (U/S) of breast. Five patients were found on breast U/S to have inflammation without evidence of focal pus and they only required antibiotics. Four patients refused aspiration and underwent primary incision and drainage under general anesthesia (GA), while in two patients the abscesses were pointing and opened spontaneously before intervention, and they settled with wound toilet and antibiotics alone. The remaining thirty two patients had their abscesses aspirated, and the treatment was successful in twenty nine patients (91%) with no complications or recurrence. The treatment failed in three patients who required subsequent incision and drainage. Conclusions: Percutaneous needle aspiration of acute small unilocular breast abscesses after prior breast (U/S) followed by systemic broad spectrum antibiotics is successful, when the abscesses are completely drained. The use of this modality of the treatment has still not found wide application in our locality. This study is an attempt to recommend its use wherever facilities exist for its feasibility, low cost, no interruption with lactation and better cosmesis, though incision and drainage still may be necessary for definitive treatment for large or multilocular abscesses. Keywords: Breast, abscess, aspiration.

Superior Ophthalmic Vein Thrombosis Developed after Orbital Cellulitis

A 65-year-old female patient presented with eye pain, swelling and blurred vision in the left eye. Routine biochemistry and microbiological analyzes were conducted. Orbital tomography (CT), magnetic resonance imaging (MRI) findings, and cerebral angiography were performed. Orbital cellulitis due to a complication of ethmoidal sinusitis was diagnosed with thrombosis of the SOV in the patient. Systemic broad-spectrum antibiotic and anticoagulant therapy was started on the patient. The patient's symptoms were recorded at the end of two weeks of the treatment.

Arrow injuries to the eye

Two male siblings aged 10 and 17 years, respectively, presented to our hospital with two days history of being shot in the right eyes with arrows. The patients presented with severe pains, bleeding, swelling, discharge and loss of vision. There was positive history of application of traditional eye medicine and an unsuccessful attempt was made to remove the arrows. Both patients presented with panophthalmitis. X-rays of the orbits and para nasal sinuses indicated the tip of the arrow was lodged to the apex of the orbit in the younger patient, and the arrow vertically traverses the eye/ orbit and lodged in the roof of the maxillary sinus in the other patient with fluid level in the lower third of the sinus. The patients were placed on broad-spectrum systemic antibiotics, had base line investigations and prepared for exploration. The patients had evisceration with removal of the arrows.

Endophthalmitis following open-globe injuries.

The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species. Recognizing early clinical signs of endophthalmitis, including pain, hypopyon, vitritis, or retinal periphlebitis may prompt early treatment with intravitreal antibiotics. Prophylaxis of endophthalmitis in high-risk open-globe injuries may include systemic broad-spectrum antibiotics, topical antibiotics, and intravitreal antibiotics to cover both Gram-positive and Gram-negative bacteria. For clinically diagnosed post-traumatic endophthalmitis, intravitreal vancomycin, and ceftazidime are routinely used. Concurrent retinal detachment with endophthalmitis can be successfully managed with vitrectomy and use of intravitreal antibiotics along with a long acting gas or silicone oil tamponade. Endophthalmitis is a visually significant complication of open-globe injuries but early wound closure as well as comprehensive prophylactic antibiotic treatment at the time of injury repair may improve visual acuity outcomes.

Ophthalmic injuries in British Armed Forces in Iraq and Afghanistan

British military ophthalmologists have not been deployed in support of operations since 2003. Eye injuries in British forces receive definitive treatment on return to the United Kingdom. We report the injury patterns, management strategies, and outcomes for eye injuries in British Armed Forces in Iraq and Afghanistan. Retrospective consecutive case series of eye injuries in British Armed Forces in Iraq or Afghanistan from July 2004 to May 2008. Outcomes assessed by final best-corrected visual acuity (VA; few patients lost to follow-up), rates of endophthalmitis, and proliferative vitreoretinopathy (PVR). There were 630 cases of major trauma, 63 sustained eye injuries (10%), and 48 sustained significant eye injuries. There were 21 open-globe injuries: 9 ruptures and perforating injuries, of which 7 were enucleated/eviscerated; 11 intraocular foreign body (IOFB) injuries, of which 1 was eviscerated. Primary repair was combined with posterior segment reconstruction in 9/11 cases with IOFB. Mean time to primary repair was 1.9 days (range 0-5). Intravitreal antibiotics were given at primary repair in five cases. All cases received early broad-spectrum systemic antibiotics. Median final VA was logMAR 0.25 excluding evisceration/enucleations. There were two cases of PVR and none of endophthalmitis. The number of eye injuries as a proportion of all casualties is lower than recently reported. The injuries are more severe than in civilian practise. The outcomes were comparable with previous reports, this demonstrates that, in certain cases, primary repair can be safely delayed beyond 24 h in the patient's best interests, in order to optimise the conditions for treatment.

Successful Treatment of Necrotizing Fasciitis in the Hind Limb of a Great Dane

A 5-month-old, intact female Great Dane was presented for an acute onset of rapidly progressive lameness, severe pain, and diffuse swelling of the right hind limb. Ultrasound evaluation revealed echogenic fluid pockets extending along fascial planes of the right hind limb, from the proximal femur to the hock. Necrotic soft tissues were debrided, and closed-suction drains were placed. No foreign material was identified at surgery. Fluid culture identified a beta-hemolytic Streptococcus sp., and affected fascial histopathology was consistent with necrotizing fasciitis. Postoperatively, the puppy was managed with intravenous broad-spectrum antibiotics, local infusions of amikacin, and daily physical rehabilitation. Oral pentoxifylline was administered to treat bronchopneumonia and streptococcal toxic shock syndrome that developed secondary to necrotizing fasciitis. To our knowledge, this is the first report of a successfully managed case of beta-hemolytic, streptococcal, necrotizing fasciitis successfully managed after a single surgical debridement in combination with systemic broad-spectrum antibiotics, local amikacin infusion, active closed-suction drainage, daily cytology, massage, and passive range-of-motion exercises to maintain limb function.

Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics

This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections. Interpretive assessment. Literature review and interpretation. Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be developed and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the development of resistance are needed. New antimicrobial agents that treat ocular infections effectively and have a low potential for the development of resistance could be a part of strategies to prevent the global increase in ocular pathogen resistance.