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Critical Reviews in Microbiology May 2024Systemic antibiotics are an effective adjunct in the treatment of periodontitis, but their judicious use is necessary as antimicrobial resistance is a growing global... (Review)
Review
Systemic antibiotics are an effective adjunct in the treatment of periodontitis, but their judicious use is necessary as antimicrobial resistance is a growing global concern. This review aims to explore the current understanding and insight related to antibiotic resistance in the subgingival microbiota of periodontitis patients. A search of MEDLINE (PubMed) was carried out from 1 January 2012 to 25 November 2021 for studies related to antibiotic resistance in periodontitis patients. Of the 90 articles identified, 12 studies were selected for inclusion. A significant incidence of antibiotic resistant isolates was reported for , , , , , , , , , and but resistance to specific antibiotics did not reach above 10% of isolates in most studies except for amoxicillin resistance in . The highest frequency of resistance across all bacterial species was for amoxicillin, clindamycin, and metronidazole. However, resistance patterns were widely variable across geographical locations, and the high heterogeneity between antibiotic-resistant isolates across studies precludes any clinical recommendations from this study. Although antibiotic resistance has yet to reach critical levels in periodontitis patients, an emphasis on antibiotic stewardship interventions such as point-of-care diagnostics and education for key stakeholders is needed to curb a growing problem.
Topics: Humans; Periodontitis; Anti-Bacterial Agents; Microbiota; Drug Resistance, Bacterial; Bacteria
PubMed: 37140235
DOI: 10.1080/1040841X.2023.2197481 -
Journal of Neurosurgery. Pediatrics Aug 2023Focal intracranial infections (epidural abscesses, subdural empyemas, and intraparenchymal abscesses) are uncommon complications of sinusitis and otitis media but can be...
OBJECTIVE
Focal intracranial infections (epidural abscesses, subdural empyemas, and intraparenchymal abscesses) are uncommon complications of sinusitis and otitis media but can be associated with significant morbidity. Treatment typically requires neurosurgical and otolaryngological interventions in combination with antibiotic treatment. Historically, children have presented to the authors' pediatric referral center with sinusitis- or otitis media-related intracranial infections in low numbers. However, since the onset of the COVID-19 pandemic, the incidence of intracranial pyogenic complications has increased at this center. The objective of this study was to compare the epidemiology, severity, microbial causes, and management of pediatric sinusitis- and otitis-related intracranial infections in the periods before and during the COVID-19 pandemic.
METHODS
All patients 21 years of age or younger who presented with an intracranial infection in the setting of sinusitis or otitis media and who underwent neurosurgical treatment at Connecticut Children's from January 2012 to December 2022 were retrospectively reviewed. Demographic, clinical, laboratory, and radiological data were systematically collated, and variables before and during COVID-19 were compared statistically.
RESULTS
Overall, 18 patients were treated for sinusitis-related (n = 16) or otitis media-related (n = 2) intracranial infections during the study period. Ten patients (56%) presented from January 2012 to February 2020, none from March 2020 to June 2021, and 8 (44%) from July 2021 to December 2022. There were no significant demographic differences between the pre-COVID-19 and COVID-19 cohorts. The 10 patients in the pre-COVID-19 cohort underwent a total of 15 neurosurgical and 10 otolaryngological procedures, while the 8 patients in the COVID-19 cohort underwent a total of 12 neurosurgical and 10 otolaryngological procedures. Surgically obtained wound cultures yielded a variety of organisms; Streptococcus constellatus/S. anginosus/S. intermedius were more prevalent in the COVID-19 cohort (87.5% vs 0%, p < 0.001) as was Parvimonas micra (62.5% vs 0%, p = 0.007).
CONCLUSIONS
At an institutional level, there has been an approximately threefold increase in cases of sinusitis- and otitis media-related intracranial infections during the COVID-19 pandemic. Multicenter studies are needed to confirm this observation and to investigate whether the mechanisms of infection are related directly to SARS-CoV-2, changes in the respiratory flora, or delayed care. The next steps will include expansion of this study to other pediatric centers throughout the United States and Canada.
Topics: Humans; Child; Retrospective Studies; Pandemics; COVID-19; SARS-CoV-2; Sinusitis; Epidural Abscess; Anti-Bacterial Agents; Otitis Media
PubMed: 37243559
DOI: 10.3171/2023.4.PEDS23130 -
Ear, Nose, & Throat Journal Nov 2023Pterygopalatine fossa (PPF) abscess is an exceedingly rare occurrence. Typically, it has been reported in association with odontogenic infections or hematogenous...
Pterygopalatine fossa (PPF) abscess is an exceedingly rare occurrence. Typically, it has been reported in association with odontogenic infections or hematogenous dissemination. In this report, we present the first case of PPF abscess where no obvious underlying cause or primary infection was evident. The patient initially presented with a 2-week history of left ptosis and persistent headaches, which were subsequently accompanied by fever and limited mouth opening. Based on elevated inflammatory markers and imaging findings, the diagnosis of a PPF abscess was established. Successful treatment was achieved through surgical drainage using an external cervical approach. Cultures from the aspirated pus identified as the causative agent. This case highlights the importance of considering PPF abscess in patients presenting with ptosis as an initial symptom. When diagnosed, surgical drainage should be considered as a viable therapeutic option.
PubMed: 38031416
DOI: 10.1177/01455613231212047 -
Open Respiratory Archives 2023
PubMed: 37842285
DOI: 10.1016/j.opresp.2023.100272 -
Gut Pathogens Jan 2024Pyogenic Liver Abscesses (PLA) are the most common type of visceral abscess. They generally develop in a context of biliary disease or hematogenous seeding, but a...
BACKGROUND
Pyogenic Liver Abscesses (PLA) are the most common type of visceral abscess. They generally develop in a context of biliary disease or hematogenous seeding, but a complete diagnostic work-up is always required in order not to miss other important causes, including above all malignancies of the gastro-intestinal tract.
CASE PRESENTATION
Herein, we report a particular case of a 80 years-old immunocompetent woman hospitalized for sepsis. At the end of the diagnostic process, Streptococcus constellatus (Sc) was identified as the cause of sepsis, multiple PLA were found together with a previous unknown ileal malignancy. We speculated about a possible correlation among these three entities (i.e. sepsis from Sc, PLA and tumors).
CONCLUSIONS
Detection of Sc in blood should raise red flags in clinicians as aggressive clinical presentation are possible.
PubMed: 38178146
DOI: 10.1186/s13099-023-00593-6 -
Optometry and Vision Science : Official... Oct 2023We present a rare case of Streptococcus constellatus -induced odontogenic orbital cellulitis.
PURPOSE
We present a rare case of Streptococcus constellatus -induced odontogenic orbital cellulitis.
METHODS
An 8-year-old boy presented to an outpatient clinic with complaints of right-sided toothache, right eye swelling, and decreased visual acuity. He was referred to a pediatric critical care department for further management. Comprehensive diagnostic assessments, such as ophthalmic examination, blood tests, computed tomography, and MRI, were performed.
RESULTS
On presentation, the best-corrected visual acuities were 20/250 and 20/20 in the right and left eyes, respectively. Examination revealed grade 2+ eyelid edema and erythema and grade 4+ chemosis and exophthalmos in the right eye. The patient displayed restricted eye movements in all directions. Blood tests revealed a total white blood cell count of 12,100 cells/μL. Axial and coronal computed tomography revealed right-sided maxillary sinus, ethmoidal sinus, and orbital abscesses. Therefore, the patient was diagnosed with septicemia, orbital cellulitis, and orbital apex syndrome in the right eye. Intravenous antibiotics were administered; paracentesis of the orbital abscess was performed under local anesthesia. However, the patient's condition worsened, resulting in a complete loss of light perception in the right eye. Accordingly, surgery was performed under general anesthesia within 24 hours of admission; the surgery involved drainage of the orbital abscess through an inferior intraorbital incision, as well as drainage of the ethmoid sinus and maxillary sinus abscesses via nasal endoscopy. A culture obtained from the orbital abscess yielded S. constellatus . The infection was managed by a combination of surgical intervention, antibiotics, steroids, and hyperbaric oxygen therapy. However, because of optic nerve injury, vision in the affected eye partially recovered to 20/200.
CONCLUSIONS
Streptococcus constellatus -induced pediatric orbital cellulitis can result in significant morbidity. The significant improvement in vision, from no light perception to 20/200, emphasizes the importance of timely diagnosis and treatment in patients who present with acute orbital cellulitis and vision loss symptoms.
Topics: Male; Humans; Child; Orbital Cellulitis; Abscess; Streptococcus constellatus; Vision Disorders; Exophthalmos; Anti-Bacterial Agents
PubMed: 37639550
DOI: 10.1097/OPX.0000000000002062 -
Infection and Drug Resistance 2023rarely causes pyopneumothorax, which is a serious state and requires a surgery. However, not every patient can tolerate surgery and individualized solutions are needed....
BACKGROUND
rarely causes pyopneumothorax, which is a serious state and requires a surgery. However, not every patient can tolerate surgery and individualized solutions are needed. Furthermore, many known situations are risk factors of infection, but pyopneumothorax associated with Hashimoto's thyroiditis has not been reported.
CASE PRESENTATION
We present the case of a 74-year-old male with multiple encapsulated pyopneumothorax caused by . Given his respiratory failure, we provided two-stage percutaneous right empyema radiography for catheter drainage in the radiology interventional department instead of surgery. Moreover, an occult Hashimoto's thyroiditis was discovered in the patient, which was possibly associated with pyopneumothorax. Levothyroxine was administered to improve his situation.
CONCLUSION
To our knowledge, it is the first case described in this context. We provided an alternative treatment for encapsulated pyopneumothorax in patient who might not tolerate surgery. We also revealed the possible relationship between pyopneumothorax and Hashimoto's thyroiditis.
PubMed: 38107434
DOI: 10.2147/IDR.S435645 -
The Pediatric Infectious Disease Journal Oct 2023Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence. (Review)
Review
BACKGROUND
Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence.
METHODS
We report a series of 10 pediatric patients (9-17 years of age) who presented with PPT in 2 tertiary care pediatric hospitals in central Israel between January 2018 and August 2022 and review the published literature on pediatric PPT.
RESULTS
The most common clinical presentations included headache (10 cases), frontal swelling (6 cases) and fever (5 cases). Symptom duration before admission was between 1 and 28 days (median 10 days). The diagnosis of PPT was made by imaging studies at a median of 1 day after admission. All 10 patients underwent computed tomography studies, and 6 patients also underwent magnetic resonance imaging. The overall rate of intracranial complications was 70%. All 10 children were treated with systemic antibiotics and surgical interventions. Streptococcus constellatus group was the most common causal bacteria. All 10 patients recovered uneventfully.
CONCLUSIONS
Our findings show that a high index of suspicion for PPT should be applied to adolescents presenting with prolonged headache and frontal swelling. Contrast-enhanced computed tomography is an appropriate first tool for the evaluation; however, an magnetic resonance imaging should be performed to determine the necessity of intracranial interventional treatments if there is any suspicion of intracranial involvement. Complete recovery can be expected with appropriate antibiotic treatment and surgical intervention in most of the cases.
Topics: Adolescent; Humans; Child; Pott Puffy Tumor; Frontal Sinusitis; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Headache; Anti-Bacterial Agents
PubMed: 37406183
DOI: 10.1097/INF.0000000000004026 -
Cureus Mar 2024Empyema is the collection of pus in the pleural cavity and most times, it occurs unilaterally. It is often associated with underlying pneumonia, but other causes have...
Bilateral Empyema With Beta Hemolytic Group C Streptococcus and Streptococcus constellatus Co-infection Resulting From an Esophageal Perforation and Associated With Septic Shock, Diffuse ST Elevation, and New-Onset Atrial Fibrillation.
Empyema is the collection of pus in the pleural cavity and most times, it occurs unilaterally. It is often associated with underlying pneumonia, but other causes have been identified as well. When it occurs after an esophageal perforation, which in itself is also rare, morbidity and mortality are even higher. Esophageal perforation can cause life-threatening complications due to its close proximity to the vital organs of the mediastinum, necessitating its timely diagnosis and aggressive management. Bacteria forming part of the normal esophageal and oral flora are the most common causative pathogens for empyema from an esophageal perforation. Streptococcus constellatus and group C Streptococci, though both rare and often not taken seriously, have been identified as individual causes of empyema. We present a case of a 58-year-old male who presented with a worsening cough, chest pain, and shortness of breath after choking on a fish bone. He was diagnosed with bilateral loculated empyema resulting from esophageal perforation with the pleural fluid culture isolating both group C streptococcus and Streptococcus constellatus. He also developed respiratory failure, mediastinitis, and septic shock. This case will enable physicians to take empyema caused by these bacteria seriously and also to include esophageal perforation as a differential diagnosis when a patient presents with bilateral empyema associated with chest pain and electrocardiographic changes.
PubMed: 38686265
DOI: 10.7759/cureus.57251 -
Journal of Infection and Chemotherapy :... Jan 2024The Streptococcus anginosus group (SAG) is a subgroup of viridans streptococci comprising three species: S. anginosus, S. constellatus, and S. intermedius. SAG usually... (Review)
Review
Clinical characteristics and mortality rates of bacteremia caused by Streptococcus anginosus group: A retrospective study of 84 cases at a tertiary hospital in South Korea.
The Streptococcus anginosus group (SAG) is a subgroup of viridans streptococci comprising three species: S. anginosus, S. constellatus, and S. intermedius. SAG usually resides in the oral cavity and colonizes the throat, and the gastrointestinal and genitourinary tracts. SAG can form abscesses in various parts of the body; however, the clinical features of SAG infection are not clear. Here, we reviewed the medical records of all SAG bacteremia patients aged over 18 years who were diagnosed between January 2010 and December 2021 at a tertiary university hospital. We then compared clinical characteristics, source of infection, need for surgical or interventional treatment, and 28-day mortality rates among each species of SAG. Differences in percentages between groups were compared using a proportion test, and differences between mean values were assessed using the Kruskal-Wallis test with post-hoc Bonferroni correction. In total, 84 cases of SAG bacteremia (40 S. anginosus cases, 31 S. constellatus cases, and 13 S. intermedius cases) were identified. The most common comorbidity was diabetes mellitus (n = 26, 31%), and the most common source was hepatobiliary infection (n = 30, 35.7%). Polymicrobial bacteremia was observed in 22.6% (19/84) of cases. Twenty-eight day mortality due to S. anginosus bacteremia was 12.5%; no deaths were reported in the S. constellatus and S. intermedius groups. However, the difference among the groups was not significant (p = 0.054). Hepatobiliary infection was the most common source of SAG bacteremia. In addition, S. anginosus bacteremia resulted in more severe disease and higher mortality rates than S. constellatus or S. intermedius bacteremia.
Topics: Humans; Adult; Middle Aged; Tertiary Care Centers; Retrospective Studies; Streptococcus anginosus; Republic of Korea; Bacteremia
PubMed: 37678749
DOI: 10.1016/j.jiac.2023.09.001