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Journal of Wound Care Sep 2023The use of ventricular assist devices (VAD) is increasing; however, diagnosis and management of device complications, such as the driveline exit site (DES) being the...
OBJECTIVE
The use of ventricular assist devices (VAD) is increasing; however, diagnosis and management of device complications, such as the driveline exit site (DES) being the portal of entry for fungal infection, is not well known.
METHOD
A systematic review involving searching PubMed (2005 to July 2020) was conducted. The case of a 43-year-old female patient who had a left VAD (LVAD) (HeartMate 3, Abbott, US) is also reported.
RESULTS
The patient was successfully treated with ketoconazole cream and oral fluconazole for likely superficial DES fungal infections. We included 36 studies that met our inclusion criteria; however, only one was included in our review. In the literature, five cases of DES fungal infection were reported, with being the only fungal pathogen.
CONCLUSION
LVAD fungal infections are uncommon but can be responsible for high mortality rates, require a prolonged period of treatment, and can present a huge problem when surgical alternatives are not available. However, species are most common. Fungal infections can only produce clear discharge, and so the classic definition of driveline infection based on purulent secretion can vary. Negative skin culture does not exclude the diagnosis of infection of the DES, and so empirical diagnosis may only be clinically based.
Topics: Female; Humans; Adult; Heart-Assist Devices; Dermatomycoses; Candida; Emollients; Patient Discharge
PubMed: 37703221
DOI: 10.12968/jowc.2023.32.Sup9a.cxc -
Nederlands Tijdschrift Voor Geneeskunde Sep 2006Chronic suppurative otitis media with underlying persistent eardrum perforation is a common cause of preventable hearing impairment. A Cochrane systematic review... (Meta-Analysis)
Meta-Analysis Review
[From the Cochrane Library: topical antibiotic treatment is more effective than systemic antibiotic treatment for chronic otitis media with eardrum perforation and purulent discharge].
Chronic suppurative otitis media with underlying persistent eardrum perforation is a common cause of preventable hearing impairment. A Cochrane systematic review compared topical treatment (antibiotics or antiseptics) with systemic antibiotics to identify which is best. Nine randomised controlled trials were included (833 randomised patients; 842 analysed patients or ears). Topical treatment with quinolones was more effective in stopping (purulent) discharge than systemic treatment with quinolones or non-quinolones. No benefit from adding systemic treatment to topical antibiotics was detected. The effects of topical non-quinolone antibiotics or antiseptics were not clear. Little is known about secondary outcomes (prevention of complications, healing the eardrum, and improving hearing) or about the efficacy and safety of topical antibiotics in the long term.
Topics: Administration, Topical; Anti-Bacterial Agents; Humans; Otitis Media, Suppurative; Treatment Outcome
PubMed: 17058460
DOI: No ID Found