Weeks Of Intravenous Antibiotic Therapy Research Articles

Infection following mini-open rotator cuff repair: a single surgeon experience

Surgical technique has been shown to influence risk of surgical site infection following rotator cuff repair (RCR). Few studies have reported the rate of infection associated with mini-open RCR. The goal of this study was to report the postoperative infection rate and risk factors for infection among patients undergoing RCR performed by a single surgeon using a modified mini-open technique. Our hypothesis was that the rate of infection after mini-open RCR would be lower than previously reported for this surgical approach. We retrospectively reviewed an institutional shoulder surgery database to identify patients who underwent mini-open RCR performed by one surgeon at an academic tertiary care institution between 2003 and 2020. Patient records were reviewed to determine which individuals returned within 3 months postoperatively with a superficial or deep surgical site infection requiring operative management. Patient demographics, preoperative clinical characteristics, intraoperative variables, microbiological findings, infection management, and clinical course after infection were recorded. Backward elimination multivariate regression was used to assess for significant risk factors for infection. Of the 925 patients identified, 823 (89%) had at least 3 months of follow-up and were included for further analysis. A majority of the patients undergoing RCR were men (57%). The mean age was 58.4 ± 9.9 years, and the mean body mass index was 29.3 ± 5.9 kg/m2. Fourteen cases (1.7%) of postoperative surgical site infection were identified in 13 patients. Ten infections (1.2%) were superficial and 4 (0.49%) were deep. The most commonly identified organisms were Staphylococcus aureus and Cutibacterium acnes. Male sex (odds ratio [OR] 4.3, 95% CI 1.2-15.3) and diabetes mellitus (OR 3.9, 95% CI 1.2-12.6) were found to be associated with greater risk of infection. The RCR construct was found to be intact in all 10 patients with superficial infections and 2 of the 4 patients with deep infections. All infections were successfully treated with 1 round of surgical débridement and wound irrigation, and with 6 or fewer weeks of intravenous antibiotic therapy. All patients with postoperative infections recovered with no sequelae at a median final follow-up of 63.5 months (range, 3-215 months). This single-surgeon series of a large patient cohort undergoing mini-open RCR over an 18-year period demonstrated a low overall infection rate of 1.7%. Only 4 infections were deep, which suggests that deep infection after mini-open RCR is uncommon and approximates infection rates seen with arthroscopic techniques.

NOSOCOMIAL ENDOCARDITIS ON AORTIC BIOPROSTHESIS, A CASE OF ACCELERATED ATHEROSCLEROSIS

Abstract Male, 79 years old, presented to the ED with chest pain and hemodynamically instability. Approximately one month prior, he underwent aortic bioprosthesis implantation for severe aortic stenosis. Pre–intervention coronary angiography revealed diffuse atheromatous plaques, none of which were stenotic. Additionally, the patient‘s medical history included paroxysmal atrial fibrillation on NOAC, hypertension and COPD. Upon admission: NIBP 80/50 mmHg, HR 150 bpm, and oxygen saturation was 85%. ECG showed atrial fibrillation with ST–segment elevation from V1 to V5. Arterial blood gas analysis revealed pH 7.25 and lactate 6 mmol/L. He received inotropic and vasopressor support, and prompt coronary angiography was performed, revealing 99% stenosis of the mid left anterior descending artery at the bifurcation with the diagonal branch, which was treated with angioplasty and coronary stent placement (Fig.1). Transthoracic echocardiography demonstrated the presence of the aortic bioprosthesis with diffusely thickened leaflets consistent with multiple vegetations. Transesophageal echocardiography confirmed a nosocomial infectious endocarditis, with mild–to–moderate stenosis, and evidence of peri–prosthetic echogenic material directed towards the left atrium, suggestive of abscess. The patient reported low–grade fever and asthenia in the weeks prior. The systemic and local inflammatory state of the endocarditis contributed to an accelerated atherosclerotic process, destabilizing the plaque and resulting in its rupture. Blood cultures identified multidrug–resistant Staphylococcus hemolyticus, for which specific antibiotic therapy was started. The patient and his family declined cardiac surgery due to high operative risk. Follow–up TEE, after approximately six weeks of intravenous antibiotic therapy, showed reduced vegetations on the bioprosthetic valve leaflets, with evolution of the previously noted large echolucent cavity, along with two similar peri–prosthetic lesions. These findings were confirmed on contrast–enhanced CT. The patient, achieving hemodynamic stability, was discharged home, continuing intravenous antibiotic therapy (OPAT protocol). At the one–month post–discharge follow–up, the patient was asymptomatic and hemodynamically stable. A repeat TEE showed normally mobile bioprosthetic valve leaflets without vegetations, and the previously noted large cavity with internal flow, consistent with cleansed abscess (Fig.2–3).

Outpatient Parenteral Antimicrobial Therapy in the Time of COVID-19: The Urgent Need for Better Insurance Coverage.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), are placing unprecedented pressure on every health care system. Patients who require weeks of intravenous antibiotic therapy after hospital discharge due to severe bacterial infections, generally referred to as outpatient parenteral antibiotic therapy (OPAT), are at increased risk for contracting and/or transmitting COVID-19 due to extensive contact with the health care system. To reduce the risk of COVID-19 among this vulnerable patient population, providers overseeing OPAT care need to consider the relative safety of the different OPAT sites of care. Home-based OPAT should be emphasized to minimize hospital stays and prevent skilled nursing facility admissions. Medicare reimbursement policies need to urgently change to provide comprehensive coverage of home infusion services.

Don’t Let Its Name Fool You: Relapsing Thoracic Actinomycosis Caused by Pseudopropionibacterium propionicum (Formerly Propionibacterium propionicum)

Patient: Male, 71-year-oldFinal Diagnosis: Thoracic actinomycosis caused by Propionibacterium propionicumSymptoms: FeverMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Diagnostic/therapeutic accidentsBackground:Pseudopropionibacterium propionicum was called Propionibacterium propionicum until a recent taxonomy change in 2016. Diseases caused by P. propionicum resemble actinomycosis and thus differ dramatically from the infectious syndromes caused by common cutaneous Propionibacterium spp. However, if treating physicians are not familiar with P. propionicum and its clinical presentations, it is possible for them to regard it as a skin contaminant such as Cutibacterium acnes (formerly Propionibacterium acnes).Case Report:A 71-year-old man with past surgical history of right pneumonectomy was admitted with right chest wall abscess and right empyema. The chest wall abscess was drained surgically, and the empyema was drained via a chest tube. The abscess culture took 5 days to grow beaded branching Gram-positive rods, and 15 days to identify them as P. propionicum. The patient received 17 days of ceftriaxone and 4 weeks of doxycycline. However, he experienced a relapse of the chest wall abscess and right empyema 4 months after discontinuation of doxycycline. Cultures from the chest wall abscess and empyema grew P. propionicum again. We treated him with ceftriaxone for 6 months followed by minocycline for 7 months along with adequate drainage.Conclusions:It is important to recognize that P. propionicum can cause thoracic actinomycosis and will likely require the prolonged treatment course typical for actinomycotic disease, which is 2 to 8 weeks of intravenous antibiotic therapy followed by 6 to 12 months of oral antibiotic therapy.

Oral Antibiotic Therapy for Bone and Joint Infections: Challenging an Intravenous Dogma

A central tenet in infectious disease is that complicated orthopedic infections require at least 4 to 6 weeks of intravenous antibiotic therapy;

Does Change in ESR and CRP Guide the Timing of Two-stage Arthroplasty Reimplantation?

Two-stage reimplantation arthroplasty is a commonly used approach for treating chronic periprosthetic joint infections. A prereimplantation threshold value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to determine infection eradication and the proper timing of reimplantation remains ill defined. We theorized that rather than a specific numeric threshold, a percentage of improvement in these serology markers might improve diagnostic accuracy in determining the timing of reimplantation. We investigated if (1) the percent, or delta, change in ESR and CRP values from preresection to prereimplantation ([INCREMENT]ESR, [INCREMENT]CRP) is a useful marker of infection eradication and (2) whether the initial PJI causative organism (resistant, nonresistant, or culture-negative) is associated with serum ESR and CRP values before and after treatment with an antibiotic spacer and parenteral antibiotic therapy. We retrospectively reviewed 300 patients, nine of whom were lost to followup, treated with a two-stage revision THA or TKA protocol between 2005 and 2014 from two separate institutional arthroplasty registries. Serum ESR and CRP values were recorded at two designated points: (1) preresection and (2) after 6 weeks of intravenous antibiotic therapy with a drug-eluting spacer and completion of an organism-specific intravenous antibiotic regimen. Patient records were reviewed electronically for causative species of infection, revision surgeries, and recurrent/persistent infection based on Musculoskeletal Infection Society criteria for a minimum of 2 years. Forty-eight of 291 patients (16%) underwent a revision procedure for recurrent or persistent infection, whereas 31 patients (10%) were revised for noninfectious reasons. The [INCREMENT]ESR, [INCREMENT]CRP, culture results, and patient demographics were recorded and analyzed with receiver operator curves controlling for American Society of Anesthesiologists (ASA) class. Receiver operator characteristic area under the curves (AUC) demonstrated that both the [INCREMENT]ESR (AUC = 0.581) and [INCREMENT]CRP (AUC = 0.539) percentages were poor markers of recurrent or persistent infection. When comparing preresection with prereimplantation values, the median percent [INCREMENT]ESR was 50% (interquartile range [IQR], 17%-77%) for those patients who remained infection-free versus 59% (IQR, 29%-78%) for those who developed reinfection (p = 0.540). The median percent [INCREMENT]CRP was 77% (IQR, 47%-92%) for those patients who remained infection-free versus 79% (IQR, 46%-95%) for those who experienced reinfection (p = 0.634). Although no significant differences were found between organism type and CRP values at the two time points, the preresection ESR level was higher in patients infected with resistant bacteria (median, 69; IQR, 60%-85%) compared with nonresistant organisms (median, 55; IQR, 33%-83%; p = 0.020). The percent change in serum ESR and CRP inflammatory markers before and after two-stage reimplantation for PJI was not associated with reinfection risk when controlling for ASA class. Although a return to normal serology infrequently occurs before reimplantation, [INCREMENT]ESR and [INCREMENT]CRP provide no additional diagnostic accuracy to determine the timing of reimplantation. Furthermore, the pre- and postresection serology values have no meaningful relationship to resistant or nonresistant pathogens. Decisions for reimplantation must take into account multiple variables rather than a specific threshold change in serum inflammatory markers. Level III, diagnostic study.

A Rare Case of Corynebacterium Endocarditis

A 26-year-old gentleman presented with a 1-month history of fevers, malaise and weight loss. He was born in China and had moved to Australia during his childhood. He was appropriately vaccinated. There was no history of recent dental procedures or illicit drug use. On examination, the temperature was 39 °C. Heart rate, blood pressure and oxygen saturations were normal. There was a pan-systolic murmur over the apex. There were small, non-tender, erythematous macules over both palms consistent with Janeway lesions. Neurological examination was unremarkable. Blood tests revealed raised inflammatory markers (C-reactive protein 87 mg/L). Four separate sets of blood cultures at admission isolated Corynebacterium pseudodiphtheriticum, sensitive to penicillin. Urgent transthoracic echocardiography revealed a large vegetation (11 × 9 mm) attached to the anterior mitral leaflet with associated moderate-severe regurgitation. Left ventricular function was preserved. The patient was commenced on empirical therapy for endocarditis, subsequently rationalised to intravenous benzylpenicillin. Embolic workup revealed multiple cerebral lesions suspicious for mycotic aneurysms and a small subacute infarction in the right frontal lobe. He underwent mechanical mitral valve replacement after 2 weeks of intravenous antibiotic therapy. Valve tissue and subsequent blood cultures were negative and the patient was discharged home following a 6-week admission.

Posttraumatic Skin and Soft-Tissue Infection due to Pseudomonas fulva.

We report a case of posttraumatic skin and soft-tissue infection in a patient with a left thigh wound after a traffic accident. Pseudomonas fulva was isolated from a wound aspirate and was identified to the species level by Maldi-tof. The patient responded to drainage, debridement of wound, and two weeks of intravenous antibiotic therapy. Follow-up after 3 weeks was satisfactory with healthy cover of the injured area.

EComment. A paradigm shift in the emergent management of aortobronchial fistula

In this interesting case report, the authors described the successful management of an acquired aortobronchial fistula (ABF) using endovascular technology [1]. The authors highlighted an extremely important point in the management of this inconsistently fatal disease if left untreated, which we welcome the opportunity to re-emphasize. The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair (TEVAR) was first described 15 years ago. Many studies have demonstrated excellent short- and long-term outcomes of TEVAR for the treatment of thoraco-abdominal aortic aneurysm, with reduced reported perioperative morbidity and mortality compared with conventional open repair. A number of case reports [2–3] and small series [4] describing the successful management of ABF using thoracic stent grafts have been published over the last 10 years. Although immediate and short-term outcomes are encouraging, the major concern is the durability of this approach in the setting of a contaminated milieu in the vicinity of foreign material. Recently, Canaud et al. [5] published a very interesting review of the literature about the mid-term results of TEVAR in patients with ABF because to date long-term follow-up studies are lacking. They identified 134 patients with ABF treated with TEVAR. Most reported cases included patients with secondary ABF (55%). Of note, recurrence of ABF occurred in 14 patients (11%) and this scenario was fatal in 50% of the cases. Stent-graft infection was observed in only 3 patients during the 17 month-period of follow-up; however, this complication was associated with substantial morbidity and mortality. They concluded that TEVAR should be considered as a first-line urgent procedure for ABF. The initial management should include at least 4 weeks of intravenous antibiotic therapy and a long-term and strict follow-up is mandatory to identify early complications. Unfortunately, the Achilles heel of TEVAR in ABF remains the lack of long-term clinical results. Further evidence and long-term results are needed to help us in determining what the best strategies in these very complex patients are.

Repetitive complications after prosthetic graft for inflammatory aortic aneurysm.

The presence of retroperitoneal fibrosis after an aortic graft replacement is a marker of poor prognosis following aortic graft replacement. Herein we report the case of a 39-year-old man with retroperitoneal fibrosis that had been causing ureteral obstruction. The man had undergone repeated aortic graft replacement due to bacteremia and aortic graft–small intestinal fistula that occurred 4 years after initial aortic grafting for an inflammatory aortic aneurysm. The patient was discharged after 4 weeks of intravenous antibiotic therapy following the latest aortic graft replacement.

Pylephlebitis: A Rare Cause of Intrabdominal Sepsis

Purpose: Intra-abdominal infections can be associated with a variety of complications. We present an unusual case of an infection of the portal vein (pylephlebitis). A 72 year-old Caucasian male with hypertension presented with epigastric pain and fevers. Initial workup revealed leukocytosis (19 K/μL) as well as mildly elevated bilirubin (1.9 mg/dL). CT scan revealed an acute left portal vein thrombosis as well as concern for a fluid collection near the hilum of the liver, possibly consistent with a hepatic abscess. Treatment was initiated with intravenous heparin as well as broad-spectrum antibiotics. The patient subsequently developed hypotension requiring pressor support, progressive renal failure, and atrial fibrillation necessitating cardioversion. Blood cultures revealed gram negative bacteremia with Veillonella species. The patient then improved with the antibiotics and anticoagulation over the next 48 hours. It was unclear whether the hilar fluid collection represented a cystic hepatic lesion or a hepatic abscess through direct extension of the pylephlebitis. Given the patient's clinical improvement, drainage of this hilar lesion was not attempted. The patient received 6 weeks of intravenous antibiotic therapy as well as Coumadin therapy. At long-term follow-up, he had no further symptoms. Repeat CT scan showed a small complex hepatic cyst, and persistence of the left portal vein thrombosis. The plan was to continue at least 6 months of anticoagulation and repeat imaging studies 6 months later. Pylephlebitis, or septic portal vein thrombosis, can complicate any intra-abdominal infection including diverticulitis, appendicitis, biliary process or even inflammatory bowel disease. It is rarely associated with an underlying hypercoagulable condition. Given its significant mortality (up to 30% even with antibiotic therapy), pylephlebitis should be considered in any patient that presents with fevers, abdominal pain, and jaundice. Early intravenous antibiotic therapy remains the mainstay of treatment. The role of anticoagulation is controversial, but appears to have a beneficial role through improved vascular recanalization, which may result in improved mortality.

Isolated gonococcal ascending aorta aneurysm

We present a very rare case of an acute septic infection and vegetative mycotic aneurysm caused by Neisseria gonorrhoeae in a 52-year old male. The aortic valve was bicuspid and calcified. He was successfully treated by the resection of the ascending aorta and the aortic valve with a replacement by separate prostheses, followed by 2 weeks of intravenous antibiotic therapy. The patient was followed up 18 months postoperatively with no signs of reinfection.

An unreported clindamycin adverse reaction: wrist monoarthritis.

Clindamycin is a lincosamide antibiotic which is approved for the treatment of Anaerobic, Streptococcal and Staphylococcal infections. There has been an increased interest in the use of clindamycin since it achieves high intracellular levels in phagocytic cells, high levels in bone and appears to have an antitoxin effect against the toxin elaborating strains of streptococci and staphylococci. Clindamycin is considered as a bacteriostatic antibiotic, while it is bactericidal against some strains of Staphylococci, Streptococci and Anaerobes such as B. fragilis. Its major disadvantage is its propensity to cause antibiotic-associated diarrhea. In spite of expanded use of clindamycin in bone infections, the adverse reactions of this antibiotic are minor. Polyarthritis is a rare adverse effect of this antibiotic. In this case report, we studied a 75-year-old male patient with past history of drop attack and subdural hematoma who developed skull osteomyelitis after the surgery. After two weeks of intravenous antibiotic therapy, wound discharge was stopped and the patient was discharged from the hospital with the maintenance oral antibiotic therapy including clindamycin 300 mg q8 h, ciprofloxacin 500 mg q12 h and rifampin 600 mg fasting. Six days after the beginning of oral antibiotics, right wrist monoarthritis was developed. It was unresponsive to nonsteroidal anti-inflammatory drug and improved after decreased doses of clindamycin. As best as we know, monoarthritis was not reported with clindamycin previously.

Time course and recovery of arterial blood gases during exacerbations in adults with Cystic Fibrosis

Introduction Hypoxia and hypercapnia are closely linked to morbidity and mortality in patients with Cystic Fibrosis (CF). The aims of this study were to describe the changes in blood gases during and following an acute pulmonary exacerbation in adults with CF. Methods We performed a prospective observational study of patients with CF admitted for management of an acute exacerbation. Blood gas and spirometric analysis was performed on admission, throughout the treatment period, and 31 days after discharge (day 45). Results At presentation, eight of nineteen patients had evidence of either hypoxia (PaO 2 < 8 kPa) and/or hypercapnia (PaCO 2 > 6.6 kPa). Blood gas parameters stabilized following two weeks of intravenous antibiotic therapy, with little difference evident in between treatment completion and subsequent review following discharge. Hypercapnia reversed in three patients, with persistent hypercapnia evident in two patients. Conclusion In our study group, hypoxemia and hypercapnia were frequently observed at presentation of the acute exacerbation. Blood gases stabilized following two weeks of intravenous antibiotic therapy, with arterial PCO 2 one month following hospital discharge generally similar to that at time of discharge.

Management of complicated shunt infections: a clinical report

The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3-6 months after therapy was completed. A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2-11 years (mean 4.4 +/- 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.

Management of Deep Wound Infection After Posterior Lumbar Interbody Fusion With Cages

To evaluate long-term treatment outcome of patients with infected posterior lumbar interbody fusion (PLIF) managed with surgical debridement and or prolonged antiobiotic treatment without removal of the interbody cages. Between 1996 and 1999, 8 out of 111 patients who underwent PLIF were diagnosed with deep wound infection (7.2%). All infected patients were clinically followed for at least 2 years after completion of the antibiotic treatment. Longer follow-up of at least 6 years duration was performed by a telephone interview. Six patients were managed with surgical debridement, wound irrigation, and primary closure of the wound. None of the patients required removal of the instrumentation. In 2 patients, the PLIF cages were repositioned in the face of infection. All 8 patients received 4 to 6 weeks of intravenous antibiotic therapy followed by another 6 to 9 weeks of oral antibiotic administration. At 2-year follow-up, no clinical or laboratory signs of recurrent infection were evident. Four of the 8 patients reported improved clinical status compared with their prefusion status. At 6-year follow-up, 3 patients had minimal disability according to the Oswestry Disability Index and 2 patients had moderate disability with residual leg pain. In cases of postoperative deep wound infection after PLIF with cages, removal of the interbody implants is not necessary. Treatment is composed of prolonged antibiotic therapy guided by antimicrobial susceptibility of the isolated bacteria and supplemented with extensive surgical debridement if needed.

Piomiositis paravertebral infantil en relación con traumatismo cerrado

Pyomyositis is an acute bacterial infection that affects striated muscle and is generally accompanied by the formation of an abscess. In most cases, the microorganism involved is Staphylococcus aureus. Clinical findings are characterized by pain, swelling and muscular edema, together with variable general symptoms. Complications include arthritis, osteomyelitis and even septic shock with a mortality of 1.8%. We report the case of an 8-year-old boy who sustained a closed lumbar injury on banging his shoulder while he was playing on a trampoline and who developed paravertebral pyomyositis complicated by sepsis. S. aureus was isolated in the blood culture. The boy subsequently developed a perivertebral abscess and finally contiguous osteomyelitis in the L3 spinous process. The patient received treatment with vancomycin and metronidazole for 6 weeks followed by cloxacillin therapy for 2 weeks (a total of 8 weeks of intravenous antibiotic therapy). Physical examination 3 months after discharge revealed no abnormalities. The possibility of pyomyositis should be borne in mind, especially in children with fever, localized muscular pain and a history of accidental or sports injuries. Early diagnosis and treatment are important to reduce the risk of possibly fatal complications.

Trends in the treatment of orthopaedic prosthetic infections.

The most commonly used therapy for prosthetic joint infection is a two-stage prosthetic exchange separated by 6 weeks of intravenous antibiotic therapy. This often results in long periods of hospitalization, morbidity, severe functional impairment and sometimes increased mortality. Therefore novel and challenging therapeutic approaches have been attempted, particularly in hip prosthetic infection. This includes, whenever possible, according to the type of microorganism, antibacterial susceptibility and clinical presentation (including age and comorbidities): (i) less aggressive surgical techniques (debridement and prosthesis retention, or re-implantation with a single-stage exchange arthroplasty); and (ii) antibiotic combinations active against biofilm-associated bacteria, including rifampicin (particularly with quinolones) with excellent bio-availability which allow prolonged and efficient oral therapy.

Méningite et ostéite à Pasteurella multocida chez un nourrisson de 3 mois

Pasteurella multocida is usually responsible for local infections occurring after animal bites. It can also be responsible for meningitis in infants. A three-month old infant was admitted to hospital with a diagnosis of bacterial meningitis and hip osteitis. Cultures of cerebrospinal fluid, blood and joint liquid were positive to Pasteurella multocida. Licking from the family dog was the transmission mode in this case. Despite initial neurological complications, clinical evolution was favourable after three weeks of intravenous antibiotic therapy followed by an oral administration for three months. Pasteurella multocida meningitis is rare in infants. It can be associated with arthritis, osteitis and septicaemia. Besides animal bites, licking is also a mode of contamination.

Hepatic abscess after liver transplantation: 1990-2000.

Infections following solid-organ transplants are a major cause of morbidity and mortality. Few studies have reported the complications of hepatic abscesses. This investigation consisted of a retrospective chart review of all solid-organ transplant recipients from 1990 to 2000. Criteria for diagnosis included parenchymal hepatic lesions, positive cultures from liver aspirates or blood cultures, or both, and a compatible clinical presentation. Of 2,175 recipients of all organ transplants (heart, lung, kidney, liver, pancreas), we identified 12 patients who had experienced 14 episodes of hepatic abscess, all in liver transplant recipients. Median time from transplant to hepatic abscess was 386 days (range 25-4,198). The most common predisposing factor was hepatic artery thrombosis (HAT), which occurred in eight patients, and was diagnosed at an average of 249 days (range 33-3,215) after transplantation. Clinical presentation of hepatic abscess was similar to that described in non-immunosuppressed patients. All but one patient showed hypoalbuminemia (<3.5 g/dL); those with HAT also had significantly elevated lactate dehydrogenase. Liver aspirates grew gram-positive aerobic bacteria (50% of isolates), gram-negative aerobic bacteria (30%), and anaerobes and yeasts (10% each). Patients received an average of 6 weeks of intravenous antibiotic therapy. Catheter drainage was successful in 70% of cases; and five patients required retransplantation. Altogether, five of the patients died, yielding a mortality rate of 42%. Hepatic abscess, a rare complication after liver transplantation, was frequently associated with hepatic artery thrombosis. Mortality was higher than in patients who had not undergone transplantation. Prolonged antibiotic therapy, drainage, and even retransplantation may be required to improve the outcome in these patients.