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Journal of Clinical Medicine Research Apr 2023Osteoarticular infections (OAIs) caused by () are a rare clinical entity. This study aimed to review all published cases of OAI due to A systematic review of PubMed,... (Review)
Review
Osteoarticular infections (OAIs) caused by () are a rare clinical entity. This study aimed to review all published cases of OAI due to A systematic review of PubMed, Scopus, and Cochrane Library was conducted to report the demographic and clinical characteristics, microbiological data, management, and outcome of OAIs caused by in the adult population. A total of 16 studies reporting on 16 patients were included in this review. Eight patients had arthritis and eight patients had osteomyelitis/discitis. The most reported risk factors were immunosuppression, poor dental hygiene/dental infections, and recent gastrointestinal (GI) endoscopy. Five cases of arthritis occurred in a native joint while three patients had prostheses. The potential source of infection was documented in more than half of the cases (56%) (most commonly odontogenic and GI sources (25% and 18%, respectively). The knee and hip joints were the most frequently affected joints in patients with arthritis, while the thoracic vertebrae were the most common sites for osteomyelitis/discitis. The blood cultures were positive in three patients with arthritis (37.5%) and five patients with osteomyelitis/discitis (62.5%). Associated endovascular infection was found in five patients with bacteremia. Contiguous spread (adjacent mediastinitis) was documented in two patients with sternal osteomyelitis and thoracic vertebral osteomyelitis. Surgical interventions were performed for 12 patients (75%). Most strains of were susceptible to penicillin and cephalosporins. All patients with reported outcomes had achieved complete recovery. is an emerging pathogen for OAIs in certain susceptible populations with specific risk factors. This review reported the demographic, clinical, and microbiological features of OAIs caused by . A careful evaluation of an underlying infectious focus is warranted to control the source. When bacteremia is present, it is also necessary to have a high index of suspicion to rule out an associated endovascular infection.
PubMed: 37187711
DOI: 10.14740/jocmr4891 -
Mycoses Aug 2023Saksenaea vasiformis is a rarely reported Mucorales causing mucormycosis in both immunocompromised and immunocompetent individuals. Due to few reported cases, the...
INTRODUCTION
Saksenaea vasiformis is a rarely reported Mucorales causing mucormycosis in both immunocompromised and immunocompetent individuals. Due to few reported cases, the clinical characteristics and optimal management strategy for this rare agent are not clearly described.
METHODS
We systematically reviewed Medline, EmBase and CINHAL for studies on S. vasiformis infections reported until 1 January 2022 and 57 studies (63 patients) were retrieved. Additionally, one more case of extensive abdominal wall necrotizing fasciitis managed by our team was also included. The clinical and demographic characteristics and outcomes were extracted and analysed.
RESULTS
Out of the 65 included cases, the majority were reported from India (26.6%). The most common risk factors for infection were accidental trauma wounds (31.3%), health-care-related wounds (14.1%) and animal/insect bites (12.5%). Most common clinical presentation was subcutaneous mucormycosis (60.9%) followed by rhino-orbito cerebral mucormycosis (14%), necrotizing fasciitis (10%), disseminated infection (9.3%), pulmonary mucormycosis (3.2%) and osteomyelitis (1.6%). Mortality was observed in 24 (37.5%) patients and health care related injuries were significantly associated with higher mortality (p = .001). The use of posaconazole (p = .019) and the use of surgical management (p = .032) was associated with significantly better survival.
DISCUSSION
In this study, we describe the largest compendium of mucormycosis due to S. vasiformis, which can be useful in increasing awareness regarding this rare Mucorales and guiding patient management.
Topics: Animals; Mucormycosis; Fasciitis, Necrotizing; Abdominal Wall; Mucorales; India; Antifungal Agents
PubMed: 37095628
DOI: 10.1111/myc.13592 -
The Pediatric Infectious Disease Journal Aug 2023Osteomyelitis is a condition that disproportionately affects those with sickle cell anemia (SCA). Despite the frequency of osteomyelitis in this population, there are...
BACKGROUND
Osteomyelitis is a condition that disproportionately affects those with sickle cell anemia (SCA). Despite the frequency of osteomyelitis in this population, there are reports of increasing life expectancy and rates of Staphylococcus aureus infections, which contrasts the belief that Salmonella is the most common organism identified. The purpose of this systematic review is to determine the most commonly identified organism and identify whether age is associated with the development of Salmonella osteomyelitis in homozygous sickle cell patients.
METHODS
A search of PubMed, EMBASE Cochrane and databases was performed for studies of all levels of evidence pertaining to osteomyelitis in SCA. Reasons for exclusion included non-English language, case reports, literature reviews, isolated septic arthritis without bony involvement and isolated oral-facial bony involvement.
RESULTS
The most common pathogen cultured was nontyphoid Salmonella , which occurred in 117 of 192 (60.9%) of cases identified. This was followed by S. aureus 41 of 192 (21.8%) and other enteric bacteria 14 of 192 (7.2%). Subgroup analysis demonstrated differences at the age of initial presentation with Salmonella cohort at 6.8 years and S. aureus cohort at 22.1 years ( P = 0.0001). On geographic analysis, African countries had an older average age of diagnosis at 13.1 years with decreased rates of Salmonella infections and increased rates of infections from other organisms compared with the US, Middle East and Europe.
CONCLUSIONS
This systematic review suggests that Salmonella is most commonly identified in patients with SCA (HbSS phenotype) especially those <12 years old presenting with acute osteomyelitis. Sub-Saharan African countries had later ages of diagnosis compared with the US, Middle East and Europe with bacterial profiles that favors a diagnosis of chronic osteomyelitis and missed acute initial presentation. Therefore, age of presentation is likely a surrogate for geographic and socioeconomic factors such as availability of medical screening and treatment.
Topics: Humans; Staphylococcus aureus; Salmonella Infections; Anemia, Sickle Cell; Salmonella; Osteomyelitis
PubMed: 37079601
DOI: 10.1097/INF.0000000000003937 -
Journal of Neurosurgery. Pediatrics Jul 2023Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific notable sequelae are otogenic (otitic) hydrocephalus and CVST management. Correspondingly, the aim of this study was to integrate the currently published metadata to summarize these outcomes.
METHODS
Electronic searches were performed using the Ovid Embase, PubMed, Scopus, and Cochrane databases from inception to November 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort-level data were then abstracted for analysis for appropriate pediatric patients. Outcomes were pooled by random-effects meta-analyses of proportions where possible.
RESULTS
Twenty-three study cohorts describing 312 pediatric patients with otogenic CVST were included. At a cohort level, the median patient age was 6 years among 181 boys (58%) and 131 girls (42%). Modeling indicated papilledema at presentation in 46% of cases (95% CI 30%-62%). Regarding management, antibiotics were applied universally in all cases, mastoidectomy or other otologic surgery was performed in 91% (95% CI 82%-98%), and prophylactic anticoagulation was administered in 86% (95% CI 75%-95%). There was only 1 case (0.3%) of postprocedural intracranial hemorrhage, and there were no deaths reported among all studies. Although diagnostic lumbar puncture was performed in 14% (95% CI 3%-28%) at presentation, clinical otogenic hydrocephalus was ultimately suspected in 31% (95% CI 14%-49%), and acetazolamide was given in 65% (95% CI 35%-91%) overall. There were 10 cases (3%) that proceeded to permanent CSF diversion in the form of ventricular shunting. At a median follow-up of 8 months among all studies, the venous sinus was completely recanalized in 67% (95% CI 53%-79%).
CONCLUSIONS
Most CVSTs following acute mastoiditis will recanalize with the standard use of antibiotics, otologic surgery, and anticoagulation, with minimal symptomatic hemorrhage risk. However, an appreciable proportion of these patients will develop symptomatic otogenic hydrocephalus, and it is imperative that the appropriate surveillance and workup is performed to fully optimize patient outcomes long-term. The possible need for permanent CSF diversion should be recognized.
Topics: Male; Female; Child; Humans; Mastoiditis; Otitis Media; Anticoagulants; Hydrocephalus; Sinus Thrombosis, Intracranial; Anti-Bacterial Agents; Retrospective Studies
PubMed: 37060317
DOI: 10.3171/2023.2.PEDS2319 -
Medicine, Conflict, and Survival Jun 2023Osteomyelitis is a serious complication associated with war-related limb injuries requiring complicated treatment regimens and management. Few reports have been... (Review)
Review
Osteomyelitis is a serious complication associated with war-related limb injuries requiring complicated treatment regimens and management. Few reports have been published from the Middle-East and North-Africa regions about the microbial aetiology of osteomyelitis caused by war injuries. The aim of this review is to collect published data about the microbiology of osteomyelitis in war-related injuries in the region and to derive targeted treatment regimens to manage these serious and limb-threatening infections. A thorough literature search was done using six search engines for pertinent articles. Articles with a minimum of five cases of osteomyelitis from war wounds, citation of microbial aetiology and mention of the timing of cultures obtained in relation to injury were included. Nine studies that met the eligibility criteria were included, involving 1644 patients and a total of 2332 cultures. Gram-negative bacteria were isolated from 1184 cultures, and Gram-positive bacteria were identified from 1148 cultures. Antibiotic coverage should be tailored for Gram-negative organisms in the early stages and Gram-positives in the chronic phase, respectively, with broader coverage reserved for critically ill patients. There is a dire need for further and larger studies about osteomyelitis from war injuries for targeted treatment.
Topics: Humans; Africa, Northern; Middle East; Osteomyelitis; War-Related Injuries
PubMed: 37045606
DOI: 10.1080/13623699.2023.2193862 -
Materials (Basel, Switzerland) Mar 2023the focus of this study is to evaluate if the combination of an antibiotic with a ceramic biomaterial is effective in treating osteomyelitis in an infected animal model... (Review)
Review
Local Antibiotic Delivery Ceramic Bone Substitutes for the Treatment of Infected Bone Cavities and Bone Regeneration: A Systematic Review on What We Have Learned from Animal Models.
AIMS
the focus of this study is to evaluate if the combination of an antibiotic with a ceramic biomaterial is effective in treating osteomyelitis in an infected animal model and to define which model and protocol are best suited for in vivo experiments of local bone infection treatment.
METHODS
a systematic review was carried out based on PRISMA statement guidelines. A PubMed search was conducted to find original papers on animal models of bone infections using local antibiotic delivery systems with the characteristics of bone substitutes. Articles without a control group, differing from the experimental group only by the addition of antibiotics to the bone substitute, were excluded.
RESULTS
a total of 1185 records were retrieved, and after a three-step selection, 34 papers were included. Six manuscripts studied the effect of antibiotic-loaded biomaterials on bone infection prevention. Five articles studied infection in the presence of foreign bodies. In all but one, the combination of an antibiotic with bioceramic bone substitutes tended to prevent or cure bone infection while promoting biomaterial osteointegration.
CONCLUSIONS
this systematic review shows that the combination of antibiotics with bioceramic bone substitutes may be appropriate to treat bone infection when applied locally. The variability of the animal models, time to develop an infection, antibiotic used, way of carrying and releasing antibiotics, type of ceramic material, and endpoints limits the conclusions on the ideal therapy, enhancing the need for consistent models and guidelines to develop an adequate combination of material and antimicrobial agent leading to an effective human application.
PubMed: 36984267
DOI: 10.3390/ma16062387 -
Otolaryngology--head and Neck Surgery :... Oct 2023To assess the effect of the pneumococcal vaccine (PCV) toward the surgical management and complications of otitis media. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the effect of the pneumococcal vaccine (PCV) toward the surgical management and complications of otitis media.
DATA SOURCES
MEDLINE, EMBASE, PubMed, Scopus, and clinicaltrial.gov.
REVIEW METHODS
A systematic search was performed using a combination of keywords and standardized terms about PCV and surgical management or complications of otitis media. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were screened by 3 independent reviewers. Risk of bias assessment, followed by meta-analysis in only randomized-controlled trials was conducted. Vaccine efficacy (VE) and 95% confidence interval (CI) were reported.
RESULTS
Of the 2649 abstracts reviewed, 27 studies were included in the qualitative analysis and were categorized into 6 outcomes: tympanostomy tube insertion, otitis media with effusion (OME), mastoiditis, spontaneous tympanic membrane (TM) perforation, recurrent acute otitis media (AOM), and severe AOM. Fifteen studies were included in the meta-analysis to evaluate the rate of tympanostomy tube insertion, OME, and recurrent AOM. PCV was significantly more effective in lowering the rate of tympanostomy tube insertion (VE, 22.2%; 95% CI, 14.6-29.8) and recurrent AOM (VE, 10.06%; 95% CI, 7.46-12.65) when compared with the control group, with no significant difference in reducing the incidence of OME. The qualitative analysis revealed that PCV had efficacy in preventing severe AOM and spontaneous TM perforation but the effect on mastoiditis remained unclear.
CONCLUSION
The PCV was effective in reducing the rate of tympanostomy tube insertion and the incidence of recurrent AOM with a nonsignificant effect in preventing OME in children.
Topics: Child; Humans; Infant; Pneumococcal Vaccines; Mastoiditis; Otitis Media; Otitis Media with Effusion; Middle Ear Ventilation
PubMed: 36924215
DOI: 10.1002/ohn.327 -
International Journal of Molecular... Feb 2023Many studies have been published assessing the association between the presence of genes and outcomes in patients with bone and joint infections (BJI), but it is not... (Review)
Review
Many studies have been published assessing the association between the presence of genes and outcomes in patients with bone and joint infections (BJI), but it is not known if they have had similar findings. A systematic literature review was performed. All available data on studies in Pubmed between January 2000 to October 2022 reporting the genetic characteristics of and the outcomes of BJIs were analyzed. BJI included prosthetic joint infection (PJI), osteomyelitis (OM), diabetic foot infection (DFI), and septic arthritis. Because of the heterogeneity of studies and outcomes, no meta-analysis was performed. With the search strategy, 34 articles were included: 15 articles on children and 19 articles on adults. In children, most BJI studied were OM ( = 13) and septic arthritis ( 9). Panton Valentine leucocidin (PVL) genes were associated with higher biological inflammatory markers at presentation ( 4 studies), more febrile days ( 3), and more complicated/severe infection ( 4). Other genes were reported anecdotally associated with poor outcomes. In adults, six studies reported outcomes in patients with PJI, 2 with DFI, 3 with OM, and 3 with various BJI. Several genes were associated with a variety of poor outcomes in adults, but studies found contradictory results. Whereas PVL genes were associated with poor outcomes in children, no specific genes were reported similarly in adults. Additional studies with homogenous BJI and larger sample sizes are needed.
Topics: Child; Adult; Humans; Staphylococcus aureus; Arthritis, Infectious; Staphylococcal Infections; Osteomyelitis; Communicable Diseases; Genomics
PubMed: 36834650
DOI: 10.3390/ijms24043234 -
One Health (Amsterdam, Netherlands) Jun 2023() disease is an important infection disease throughout the world. () is a common . Extrapulmonary infections due to , particularly spine infections, are a rare...
BACKGROUND AND PURPOSE
() disease is an important infection disease throughout the world. () is a common . Extrapulmonary infections due to , particularly spine infections, are a rare occurrence, but lack of research is cited as a constraint for implementing control in such patients. The purposes of this paper are to describe a case of spondylodiscitis, to review the published literature on cases of spine infections, and to summarize the predisposing factors, diagnosis, and treatment of infection.
METHODS
A case of spondylodiscitis was caused by in a patient with systemic lupus erythematosus (SLE). Research was conducted using the PubMed, ScienceDirect, Embase, Wiley Online Library, and Scopus databases using the following search terms: "", "vertebral", "spinal", "spondylodiscitis", "infection", and "osteomyelitis".
RESULTS
We retrieved 14 cases published before August 2022. The risk factors for infection were iatrogenic infections (3/14, 21.43%), SLE (4/14, 28.57%), AIDS (4/14, 28.57%), and immunocompetence without any comorbidities (3/14, 21.43%). The most common sites of infection were thoracic vertebrae (10/14, 71.43%) and lumbar vertebrae (4/14, 28.57%). A total of 14 cases were isolated and identified as from a toad by mycobacterial culture. The identification time was 55.00 ± 7.55 days (the present report identification time of metagenomic next generation sequencing (mNGS) was only 2 days). All patients were treated with antibiotic therapy, and the duration of treatment was 13.18 ± 2.13 months. Clarithromycin-based therapy showed a higher improvement rate (5/6, 83.33%). Surgical intervention was performed in 5 patients. Only 1 patient did not show any improvement after surgical treatment.
CONCLUSION
spine infection in humans presents with atypical clinical symptoms. mNGS identification may be a good choice. may be considered in immunocompromised patients with spinal infection. We recommend a clarithromycin-containing regimen and prolonging the duration of treatment to ensure effectiveness.
PubMed: 36817979
DOI: 10.1016/j.onehlt.2023.100502 -
Clinical Otolaryngology : Official... May 2023To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and... (Review)
Review
OBJECTIVES
To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management.
DESIGN
Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines.
RESULTS
Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively.
CONCLUSION
There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
Topics: Humans; Male; Aged; Female; Otitis Externa; Retrospective Studies; Risk Factors
PubMed: 36759416
DOI: 10.1111/coa.14041