Weeks Of Antimicrobial Therapy Research Articles

Bacteremia caused by Desulfovibrio desulfuricans with the intestinal tract as the portal of entry: two case reports and a literature review

BackgroundDesulfovibrio desulfuricans (D. desulfuricans), a commensal anaerobic gram-negative rod endemic to the soil environment and human gastrointestinal tract, rarely causes bloodstream infections. We report two rare cases of bacteremia caused by D. desulfuricans in which the intestinal tract was the portal of entry. In addition, we summarize findings on D. desulfuricans.Case presentationCase 1: A 51-year-old man presented to the emergency department with the chief complaints of fever and right lower abdominal pain. He was admitted to the hospital with ascending colonic diverticulitis and received empirical antibacterial therapy with piperacillin/tazobactam. Blood culture revealed D. desulfuricans. The patient was discharged after 2 weeks of antimicrobial therapy. Case 2: A 95-year-old woman presented to our hospital with a chief complaint of fever. Owing to an elevated inflammatory response and pyuria, the patient was diagnosed with pyelonephritis and treated with ceftriaxone. Klebsiella pneumoniae was detected in her urine culture, while D. desulfuricans was detected in her blood culture. The patient was then treated with ampicillin/sulbactam for 14 days. The fecal occult blood test result was positive, suggesting a colonic mucosal lesion, such as a malignant tumor, may have been the portal of entry for D. desulfuricans bacteremia. Previous literature reviews indicate that D. desulfuricans bacteremia often results from liver or renal abscesses, intestinal lesions, among others, serving as the portal of entry. Although no specific underlying disease has been reported, it is more common in the older population. We encountered two cases of D. desulfuricans bacteremia and combined them with 15 cases from previous studies to explore the characteristics of the disease. The proportion of patients aged \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\ge\\:$$\\end{document}60 years was 73.7%; overall, 73.7% had gastrointestinal complications, and 63.2% had abdominal symptoms at the time of presentation.ConclusionsWe encountered two rare cases of D. desulfurican bacteremia. This type of bacteremia is more common in elderly people over 60 years of age and is often associated with hepatobiliary and gastrointestinal diseases.

IL-1β may be an indicator of peritoneal deterioration after healing of peritoneal dialysis-associated peritonitis

BackgroundPeritoneal dialysis (PD) is an essential lifesaving treatment for end-stage renal disease. However, PD therapy is limited by peritoneal inflammation, which leads to peritoneal membrane failure because of progressive peritoneal deterioration. Peritonitis is the most common complication in patients undergoing PD. Thus, elucidating the mechanism of chronic peritoneal inflammation after PD-associated peritonitis is an urgent issue for patients undergoing PD. This first case report suggests that an increased interleukin-1β (IL-1β) expression in the peritoneal dialysate after healing of peritonitis can contribute to peritoneal deterioration.Case presentationA 64-year-old woman was diagnosed with diabetes mellitus 10 years ago and had been started on PD for end-stage renal disease. One day, the patient developed PD-associated acute peritonitis and was admitted to our hospital for treatment. Thus, treatment with antimicrobial agents was initiated for PD-associated peritonitis. Dialysate turbidity gradually disappeared after treatment with antimicrobial agents, and the number of cells in the PD fluid decreased. After 2 weeks of antimicrobial therapy, peritonitis was clinically cured, and the patient was discharged. Thereafter, the patient did not develop peritonitis; however, residual renal function tended to decline, and peritoneal function also decreased in a relatively short period. We evaluated pro-inflammatory cytokine levels before and after PD-associated peritonitis; interestingly, the levels of IL-1β remained high in the PD fluid, even after remission of bacterial peritonitis. In addition, it correlated with decreased peritoneal function.ConclusionsThis case suggests that inflammasome-derived pro-inflammatory cytokines may contribute to chronic inflammation-induced peritoneal deterioration after PD-related peritonitis is cured.

Diagnostic, clinical management, and outcome of bone flap-related osteomyelitis after cranioplasty

ObjectivesWe aimed to describe diagnostic, management, and outcome of bone flap-related osteomyelitis after cranioplasty. MethodsPatients followed up in our tertiary care hospital for bone flap-related osteomyelitis after cranioplasty were included in a retrospective cohort (2008-2021). Determinants of treatment failure were assessed using logistic regression and Kaplan-Meier curves analysis. ResultsThe 144 included patients (81 [56.3%] males; median age 53.4 [interquartile range [IQR], 42.6-62.5] years) mostly presented wound abnormalities (n = 115, 79.9%). All infections were documented, the main pathogens being Staphylococcus aureus (n = 64, 44.4%), Cutibacterium acnes (n = 57, 39.6%), gram-negative bacilli (n = 40, 27.8%) and/or non-aureus staphylococci (n = 34, 23.6%). Surgery was performed in 140 (97.2%) cases, for bone flap removal (n = 102, 72.9%) or debridement with flap retention (n = 31, 22.1%), along with 12.7 (IQR, 8.0-14.0) weeks of antimicrobial therapy. After a follow-up of 117.1 (IQR, 62.5-235.5) weeks, 37 (26.1%) failures were observed: 16 (43.2%) infection persistence, three (8.1%) relapses, 22 (59.5%) superinfections and/or two (1.7%) infection-related deaths. Excluding superinfections, determinants of the 19 (13.4%) specific failures were an index craniectomy for brain tumor (odds ratio = 4.038, P = 0.033) and curettage of bone edges (odds ratio = 0.342, P = 0.048). ConclusionPost-craniectomy bone flap osteomyelitis are difficult-to-treat infection, necessitating prolonged antimicrobial therapy with appropriate surgical debridement, and advocating for multidisciplinary management in dedicated reference centers.

Blalock-Taussig Shunt Blockage Caused by Small Colony Variants of Enterococcus faecalis.

To the Editors: Small colony variants (SCVs) constitute a subpopulation of nutrient-demanding bacteria that grow slower than the wild type. Selection pressure exerted by environmental factors, such as antimicrobial agents.1,2 SCVs of Enterococcus sp. are less frequent. We report the first case of Blalock–Taussig shunt (BTS) blockage caused by SCVs of Enterococcus faecalis. A 1-year-old boy diagnosed with tetralogy of Fallot underwent left BTS surgery and closure of patent ductus arteriosus 10 months before presentation. On postoperative day 11, a catheter-related bloodstream infection (CRBSI) was caused by E. faecalis. The peripherally inserted central catheter was removed. Echocardiography revealed the absence of verrucae, and the modified Duke criteria were not definite. Ampicillin was administered for 2 weeks; 4 months postcompletion of this therapy, the left BTS was occluded, and a right BTS surgery was performed with the left BTS remaining in place. Although he underwent this surgery for endocardial repair, the left BTS was only removed during the operation, as pus was found in the occluded left BTS during the intraoperative manipulation. No bacteria were detected in the pus using Gram staining, but vancomycin was administered for suspected shunt infection. After 2 days of culture, colonies of approximately 0.2–1 mm and 2–3 mm diameters were observed on the blood agar medium maintained in an aerobic environment and the Brucella HK agar (Kyokuto, Inc. Tokyo, Japan) medium maintained in an anaerobic environment, respectively (Fig. 1). Although biochemical analysis indicated Enterococcus spp., identification and drug sensitivity test performed using Micro Scan Walkaway 40 plus (Beckman Coulter, Inc. CA) indicated poor growth after 24 hours of incubation. Matrix-assisted laser desorption/ionization–time-of-flight analysis indicated the presence of E. faecalis; hence, the antimicrobial was changed to ampicillin, which was administered for 4 weeks to control the mediastinitis. He was discharged without sequelae and had no recurrence of bacteremia for over a year.FIGURE 1.: Bacterial colonies cultured using blood agar and Brucella HK agar media.SCVs originated due to stresses, such as perioperative exposure to antimicrobials used to treat E. faecalis bacteremia. In addition, the short duration of antimicrobial therapy used to treat CRBSI may be another reason. Enterococcus spp. bacteremia is considerably associated with the occurrence of infectious endocarditis (IE) caused by a prosthetic valve; hence, echocardiography is recommended.3 In this case, antimicrobials were administered for 2 weeks. However, 4–6 weeks of antimicrobial therapy may be appropriate for treating IE. SCVs, with a typical phenotype of low virulence and long-term persistence, adapt to the intracellular environment more efficiently than the wild type. We have listed previously reported cases of SCVs of Enterococcus spp. (Table Supplemental Digital Content 1, https://links.lww.com/INF/E930,); half of which were IE, including two cases of IE related to prosthetic valves, which may be attributed to the fact that SCVs tend to form biofilms, leading to infection in prostheses.4 Moreover, Enterococcus spp. have higher probability of forming biofilms than other bacteria. E. faecalis is particularly more prone to biofilm formation than E. faecium.5 This case indicates that SCVs of E. faecalis may survive for a long period, especially in case of artifact infection.

Subacute Epiglottitis Causing Polypoid Laryngeal and Glottic Masses

72-year-old woman with history of chronic obstructive pulmonary disease, diabetes mellitus, and tobacco use presented to hospital with a one-month history of progressive shortness of breath with dysphagia and a one day history of stridor requiring intubation for airway obstruction. Direct laryngoscopy revealed obstructive well-circumscribed glottic mass with supraglottic edema and a polypoid laryngeal mass. Biopsy of mass demonstrated only acute inflammation tissue with no tumor. She became febrile with blood and sputum cultures positive for group G Streptococcus and was started on antibiotic treatment. After one week of antimicrobial therapy, repeat laryngoscopy showed complete resolution of glottic mass leading to clinical diagnosis of bacterial epiglottitis due to group G Streptococcus. The patient was ultimately extubated with a full recovery.

Acute heart failure associated with toxic shock syndrome due to methicillin-susceptible Staphylococcus aureus during the postpartum period: case report and systematic literature review

BackgroundToxic shock syndrome (TSS) caused by Staphylococcus aureus in the postpartum period is a rare but life-threatening disease. We present a case of acute heart failure as the initial presentation of TSS due to methicillin-susceptible Staphylococcus aureus (MSSA) and describe its clinical characteristics with a systematic literature review.Case presentationA 34-year-old woman, 8 days after a normal vaginal delivery presented to our hospital with dyspnea and fever. She had jugular venous distension, bilateral leg edema, and erythema. Laboratory examinations revealed elevated NT-pro-BNP level of 3,233 pg/mL. Transthoracic echocardiography showed elevated tricuspid regurgitation peak gradient, with decreased respiratory variability of the inferior vena cava diameter and bilateral pleural effusions. The patient was hospitalized with suspicion of congestive heart failure. MSSA positive for toxic shock syndrome exotoxin-1 was detected in the culture of the perineal incision wound, and we diagnosed TSS caused by MSSA. Intravenous diuretics were administered, along with eventual cefazolin plus clindamycin. After 2 weeks of antimicrobial therapy, the patient showed improvement and was discharged. No recurrence was observed at the 24-month follow-up.ConclusionThis is a rare case report of acute heart failure being the initial manifestation of TSS due to MSSA in the postpartum period. Clinicians should consider TSS as a possibility in postpartum patients with acute heart failure. This systematic review provides insights into its clinical features, treatment regimens, and prognosis of TSS by S. aureus in the postpartum period. TSS requires an appropriate, prompt diagnosis, because delayed treatment can be fatal.

Jejunal Intussusception Caused by a Nasointestinal Ileus Tube.

A 79-year-old man was admitted to our hospital due to pleural empyema. After 4 weeks of antimicrobial therapy and pleural drainage, he recovered but complained of new-onset abdominal pain. Abdominal computed tomography revealed adhesive small bowel obstruction and a nasointestinal ileus tube with intermittent suction was inserted. This procedure initially decreased his abdominal pain, but severe abdominal pain and vomiting developed 3 days later. Repeat abdominal computed tomography revealed jejuno-jejunal intussusception due to the nasointestinal ileus tube. Our patient was initially treated conservatively. However, he underwent surgical reduction due to clinical deterioration 1 day after diagnosis and died from a surgical complication 19 days later. Intussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube in the small intestine. Because urgent operative reduction is needed to avoid intestinal resection in most cases, early diagnosis and surgical reduction of intussusception are critical.LEARNING POINTSIntussusception is a rare but fatal complication caused by placement of a nasointestinal ileus tube.Intussusception should be suspected if abdominal pain and distention worsen after placement of a nasointestinal ileus tube.Urgent operative reduction is needed for intussusception due to a nasointestinal ileus tube.

Mycotic aneurysm due to Pasteurella multocida.

Pasteurella multocida, a zoonotic infectious pathogen, is a rare cause of mycotic aneurysms in human hosts. A 61-year-old male patient with myelodysplastic syndromes (MDS) was admitted due to fever, chills, and malaise. He had been frequently licked by his pet dog. Soon after admission, a bloodstream infection due to P. multocida was found, and he received two weeks of antimicrobial therapy. However, the bloodstream infection recurred at short intervals. Computed tomography revealed a mycotic aneurysm for which he underwent aortic graft placement. Mycotic aneurysms should be considered in patients with recurrent bloodstream infections due to Pasteurella, especially if they recur at short intervals in patients with a preexisting immunocompromised state.

350. Outcomes for Joint Arthroplasty in Persons Living with HIV

BackgroundPersons living with HIV (PLHIV) now have dramatically improved life-expectancy with age-related morbidities requiring total joint arthroplasties. We present here an institutional review of PLHIV who underwent total joint arthroplasty and prosthesis-related adverse outcomes at one year.MethodsThis was a retrospective chart review in a large academic medical center. Inclusion criteria were adult PLHIV undergoing total joint arthroplasty between 2013 and 2017. Arthroplasty-related adverse outcomes within the first-year post-surgery were recorded. Patients were identified using ICD-10 codes and classified as having a PJI using Infectious Diseases Society of America (IDSA) criteria.ResultsA total of 40 patients met the criteria. The median age was 59 years and 53% of patients were male. The median CD4 count and RNA viral load were 587 (range 94–1920) cells/mm3 and 0 (range 0—189,000) copies/mL, respectively. The most common procedure was hip replacement (55%) and the most common indication for arthroplasty was avascular necrosis (43%). Adverse outcomes including PJI, dislocation, prosthesis loosening, seroma and chronic pain were identified in 28% of patients. PJI occurred in two patients and both required surgical revision. Modifiable risk factors present in both patients were active smoking, history of substance use disorder, chronic pulmonary disease, depression and hepatitis C antibody positivity. Both patients had CD4 counts >600 cells/mm3. Both were on atazanavir containing antiretroviral regimens. Neither patient was screened for MRSA carriage. Causal organisms were MRSA and MSSA respectively and each patient received 6 weeks of antimicrobial therapy.ConclusionThis study supports that when medically optimized, PLHIV have favorable outcomes. The two patients who developed PJI had multiple non-HIV modifiable risk factors predisposing them to PJI. In one case, the patient’s isolated organism was MRSA, for which the patient did not receive appropriate pre-operative antimicrobial prophylaxis. This highlights the importance of routine screening for appropriate pre-operative prophylaxis in patients undergoing joint arthroplasty, independent of HIV status.Disclosures All authors: No reported disclosures.

Diagnosis and management of acute osteoarticular infections in children.

Acute hematogenous osteomyelitis and septic arthritis are not uncommon infections in children and should be considered as part of the differential diagnosis of limb pain and pseudoparalysis. Most bone infections in children arise secondary to hematogenous seeding of bacteria into bone. The most common pathogens are Staphylococcus aureus and Kingella kingae. Children with septic arthritis should be evaluated promptly by orthopedic specialists for aspiration and possible debridement of concomitant osteomyelitis. Optimal empiric therapy after appropriate cultures continues to be intravenous cefazolin. In most cases, conversion to oral antimicrobials should occur when the patient has clinically improved and has decreasing inflammatory markers. For most uncomplicated cases of osteomyelitis, current recommendations are 3 to 4 weeks of antimicrobial therapy compared with the 6 weeks previously recommended.

Cutaneous candidiasis infection in two alpacas

SummaryTwo six-year-old macho alpacas from southeastern Alabama were presented to our Large Animal Teaching Hospital for a two-week history of pruritic, ulcerative skin lesions around the eyes, hind legs and...

Aortic Aneurysm as a Cause of Hemoptyses

Infected aortic aneurysms are a clinical condition associated with high morbidity and mortality. Hemoptysis has been reported following erosion of the aneurysm into the lung parenchyma. We present a 79-years-old woman, with history of a pseudoaneurysm of the descending aorta submitted to an endovascular correction with tubular stent in 2010. She arrived at the emergency department, in January/2016, referring asthenia and weight loss, with three months of evolution, associated with small volume hemoptysis, that had begun that day. The patient presented anemia and with hypoxemic respiratory failure. Angio-CT scan revealed hematoma of the aneurysmal sac, without indication for urgent intervention. She was admitted at an intermediate care unit. The patient kept small volume hemoptysis. A new thoracoabdominal angio-CT was performed compatible with infectious process/abscess of the periprosthetic aortic wall, associated with areas of parenchyma necrosis of the left lower pulmonary lobe, that may be the origin of hemoptysis. Empirical antibiotic therapy was instituted with pipracilina/tazobactam and linezolid. A methicillin resistant Staphylococcus aureus was identified in bronchial lavage, and piperacillin/tazobactam was suspended. After 6 weeks of antimicrobial therapy, she presented clinical improvement. This case demonstrates the complexity of managing a patient in which the infectious focus control is not possible, given the high surgical risk in a patient with multiple comorbidities. Doubts remain about the antibiotic therapy to be maintained and its duration.

Clinical outcomes of Ghanaian Buruli ulcer patients who defaulted from antimicrobial therapy.

Buruli ulcer (BU) is a tropical skin disease caused by infection with Mycobacterium ulcerans, which is currently treated with 8 weeks of streptomycin and rifampicin. The evidence to treat BU for a duration of 8 weeks is limited; a recent retrospective study from Australia suggested that a shorter course of antimicrobial therapy might be equally effective. We studied the outcomes of BU in a cohort of Ghanaian patients who defaulted from treatment and as such received less than 8 weeks of antimicrobial therapy. A number of days of antimicrobial therapy and patient and lesion characteristics were recorded from charts from a cohort of BU patients treated at Nkawie-Toase hospital between 2008 and 2012. Patients who defaulted from treatment were retrieved, and lesion characteristics and functional limitations were recorded. About 54% of patients defaulted from therapy or wound care. Forty-seven defaulters with follow-up completed had received <56 days of antibiotics. 84% of these patients healed after 32 days or less of antibiotics. There appeared to be an increased rate of healing in smaller lesions; 94% of WHO category I lesions had healed after 32 days or less of antibiotics. Although numbers were small, and a potential for bias exists, our findings suggest that a reduction in the duration of antimicrobial therapy in BU in small, early lesions is feasible. These findings can serve as a basis for future well-designed studies.

Hepatosplenic Abscesses and Osteomyelitis of the Spine in an Immunocompetent Adult with Cat Scratch Disease.

We present an 18-year-old, immunocompetent Austrian military conscript with cervical lymphadenopathy, fever, back-pain, and persistent inflammation markers despite two weeks of antimicrobial therapy with ampicillin/sulbactam. All specific laboratory investigations for identification of a specific etiology, including blood cultures and autoantibodies, were inconspicuous. Abdominal computed tomography showed multiple hypodense hepatosplenic lesions and osteomyelitis of the thoracic and lumbar spine with base plate fracture. Based on the patient's history, clinical presentation, and radiological findings, serology for cat scratch disease (CSD) was performed and high B. henselae specific IgM and IgG antibodies were detected. Due to its variety of clinical presentations, diagnosis of CSD is challenging, especially in the absence of a history of specific exposure. This case report shall remind the physician that cat scratch disease is a common disease, mainly presenting with fever and lymphadenopathy in young patients. Nevertheless CSD has many different and rare forms of presentations, including hepatosplenic lesions and bone involvement as shown in this case.

Good quality of life in former Buruli ulcer patients with small lesions: long-term follow-up of the BURULICO trial.

BackgroundBuruli Ulcer is a tropical skin disease caused by Mycobacterium ulcerans, which, due to scarring and contractures can lead to stigma and functional limitations. However, recent advances in treatment, combined with increased public health efforts have the potential to significantly improve disease outcome.ObjectivesTo study the Quality of Life (QoL) of former Buruli Ulcer patients who, in the context of a randomized controlled trial, reported early with small lesions (cross-sectional diameter <10 cm), and received a full course of antibiotic treatment.Methods127 Participants of the BURULICO drug trial in Ghana were revisited. All former patients aged 16 or older completed the Dermatology Life Quality Index (DLQI) and the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF). The WHOQOL-BREF was also administered to 82 matched healthy controls. Those younger than 16 completed the Childrens' Dermatology Life Quality Index (CDLQI) only.ResultsThe median (Inter Quartile Range) score on the DLQI was 0 (0–4), indicating good QoL. 85% of former patients indicated no effect, or only a small effect of the disease on their current life. Former patients also indicated good QoL on the physical and psychological domains of the WHOQOL-BREF, and scored significantly higher than healthy controls on these domains. There was a weak correlation between the DLQI and scar size (ρ = 0.32; p<0.001).ConclusionsBU patients who report early with small lesions and receive 8 weeks of antimicrobial therapy have a good QoL at long-term follow-up. These findings contrast with the debilitating sequelae often reported in BU, and highlight the importance of early case detection.

Pyogenic Sacroiliitis in Children: Two Case Reports

Pyogenic sacroiliitis is rare and accounts for approximately 1-2% of osteoarticular infections in children. Considerable delay between presentation and diagnosis is recognized. Two cases of pyogenic sacroiliitis are described. The first case is a 28-month-old girl presented with acute onset of fever, pain in the left hip, and limpness. Computed tomography (CT), bone scans, and magnetic resonance imaging (MRI) of the pelvis showed characteristic findings of infectious sacroiliitis, and blood cultures were negatives. The second case is a 13-year-old girl presented with acute onset of fever, pain in the right hip, and buttock, with inability to walk. The diagnosis of pyogenic sacroiliitis was confirmed by bone scans, and CT of the pelvis and blood cultures have identified Proteus mirabilis. The two children recovered fully after 6 weeks of antimicrobial therapy. Pyogenic sacroiliitis is an uncommon disease in children. The key to successful management is early diagnosis in which CT, bone scans, and MRI findings play a crucial role. If the diagnosis is established promptly, most patients can be managed successfully with antimicrobial therapy.

Rhodococcus equi infection after reduction mammaplasty in an immunocompetent patient

The majority of infections caused by R. equi occur in hosts with some degree of cell-mediated immunodeficiency. Immunocompetent individuals are infrequently affected and usually present with localized disease. Infections of the skin or related structures are uncommon and are usually related to environmental contamination. The microbiology laboratory plays a key role in the identification of the organism since it may be mistaken for common skin flora. We describe a 31 year-old woman without medical problems who presented nine weeks after breast reduction with right breast cellulitis and purulent drainage from the surgical wound. She underwent incision and drainage, and cultures of the wound yielded Rhodococcus equi. The patient completed six weeks of antimicrobial therapy with moxifloxacin and rifampin with complete resolution.

Usefulness of C-Reactive Protein for Evaluating Clinical Outcomes in Cirrhotic Patients with Bacteremia

Background/AimsThe purpose of this study was to evaluate the value of initial C-reactive protein (CRP) as a predictor of clinical outcome and to investigate whether follow-up CRP measurement is useful for the prediction of the clinical outcome of bloodstream infections in patients with liver cirrhosis (LC), whose CRP production in response to infection may be attenuated.MethodsA retrospective, observational study including 202 LC patients with Escherichia coli or Klebsiella pneumoniae bacteremia was conducted to assess the usefulness of serial CRP measurements in predicting clinical outcome in LC patients. The CRP ratio was defined as the ratio of the follow-up CRP level to the initial CRP level.ResultsThe overall 30-day mortality rate of the study population was 23.8% (48/202). In the multivariate analysis, advanced age (≥ 70 years), healthcare-associated or nosocomial infections, model for end-stage liver disease (MELD) score of ≥ 30, and initial body temperature of < 37℃ were significant factors associated with mortality (all p < 0.05). No association between initial CRP level and mortality was found. In a further analysis including 87 evaluable cases who had repeated CRP measurements at day 4 and/or 5, a CRP ratio of ≥ 0.7 was found to be a significant factor associated with mortality (odds ratio, 19.12; 95% confidence interval, 1.32 to 276.86; p = 0.043) after adjusting for other confounding variables.ConclusionsInitial CRP level did not predict mortality of sepsis in LC patients. However, serial CRP measurements during the first week of antimicrobial therapy may be useful as a prognostic factor for mortality in LC patients.

Native Mitral Valve Destruction Due to Moraxella nonliquefaciens

Moraxella species are a group of gram-negative, oxidase- and catalase-positive coccobacilli. These organisms usually do not grow on MacConkey agar, and the nitrate test is negative. Moraxella species may cause eye infections including conjunctivitis, endophthalmitis, and corneal ulcers. We report a case of native mitral valve endocarditis caused by Moraxella nonliquefaciens in a patient with a history of rheumatoid arthritis. She developed embolic complications on the third week of antimicrobial therapy. Transesophageal echocardiogram showed severe mitral regurgitation and perforation of valvular leaflets. The patient underwent successful mitral valve replacement with recovery of motor functions. This case illustrates that M. nonliquefaciens can be complicated with embolic phenomena and that early surgical intervention may be useful in selected patients to prevent embolic complications and disability. To our knowledge, this is the first reported case of native valve endocarditis caused by this organism.

Six weeks antibiotic therapy for all bone infections: results of a cohort study

There is no consensus on the antibiotic therapy for bone infection due to the heterogeneous spectrum of diseases. Most authors suggest different durations of treatment based on pathophysiological considerations. However, adverse effects are related, at least in part, to the duration of treatment. We, therefore, investigated a 6 weeks antibiotic combination therapy for all cases of bone infection. Herewith, we report the results of this therapeutic approach. This is a cohort study including all patients presenting with bone infection, regardless of the mechanism involved. The diagnosis was based on bone biopsy obtained through invasive procedures. Chronic bone infection was defined as a history of disease of over 1 month duration. The duration of clinical follow-up following treatment discontinuation was at least 6 months. Cured bone infection was defined as the absence of relapse after antibiotic discontinuation. One hundred and eighteen patients were included between July 2005 and March 2009; 61 presented with bone infection following prosthetic implant (52%) and the 57 remaining patients had bone infection without foreign material (48%). Surgery was required for 80 patients (68%). Microbial agents were identified in 116/118 patients, with 24 patients presenting with polymicrobial sepsis (20%). The mean duration of antibiotic treatment was 42 +/- 0.2 days and the mean clinical follow-up was 27 +/- 14 months. The treatment success rate was 91.5% (108/118). Six weeks of antimicrobial therapy appears to be effective for nearly all bone infections, regardless of the pathophysiology. These results encourage us to pursue attempts to simplify the management of bone infection without obvious prejudice to the patient.