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Orthopaedic Surgery Jun 2024Surgical site infection (SSI) after spinal surgery is still a persistent worldwide health concern as it is a worrying and devastating complication. The number of samples...
OBJECTIVE
Surgical site infection (SSI) after spinal surgery is still a persistent worldwide health concern as it is a worrying and devastating complication. The number of samples in previous studies is limited and the role of conservative antibiotic therapy has not been established. This study aims to evaluate the clinical efficacy and feasibility of empirical antibiotic treatment for suspected early-onset deep spinal SSI.
METHODS
We conducted a retrospective study to identify all cases with suspected early-onset deep SSI after lumbar instrumented surgery between January 2009 and December 2018. We evaluated the potential risks for antibiotic treatment, examined the antibiotic treatment failure rate, and applied logistic regression analysis to assess the risk factors for empirical antibiotic treatment failure.
RESULTS
Over the past 10 years, 45 patients matched the inclusion criteria. The success rate of antibiotic treatment was 62.2% (28/45). Of the 17 patients who failed antibiotic treatment, 16 were cured after a debridement intervention and the remaining one required removal of the internal fixation before recovery. On univariate analysis, risk factors for antibiotic treatment failure included age, increasing or persisting back pain, wound dehiscence, localized swelling, and time to SSI (cut-off: 10 days). Multivariate analysis revealed that infection occurring 10 days after primary surgery and wound dehiscence were independent risk factors for antibiotic treatment failure.
CONCLUSION
Appropriate antibiotic treatment is an alternative strategy for suspected early-onset deep SSI after lumbar instrumented surgery. Antibiotic treatment for suspected SSI occurring within 10 days after primary surgery may improve the success rate of antibiotic intervention. Patients with wound dehiscence have a significantly higher likelihood of requiring surgical intervention.
PubMed: 38887157
DOI: 10.1111/os.14106 -
Cureus May 2024Background Cerament V (CV) is a bioactive bone graft substitute with vancomycin as an antimicrobial agent designed for the management of bone defects and infections. In...
Background Cerament V (CV) is a bioactive bone graft substitute with vancomycin as an antimicrobial agent designed for the management of bone defects and infections. In this retrospective case series, we aim to evaluate the clinical outcomes of patients treated with CV for fracture-related infections (FRI). Methods All patients who received treatment for FRI and whose dead space and bone reconstruction management was solely done utilizing CV were included. The patients were recruited between September 2015 and September 2022. Data including patient demographics, primary diagnosis, surgical procedure, antibiotic therapy, microbiological results, complications, and follow-ups were recorded. Outcomes were assessed, including the percentage of bone void filling on radiographs, infection resolution, adverse effects, and patient-reported outcome measures by EQ-5D-5L. Results We present in this retrospective case series seven patients (three female) with a mean age of 56.86 ± 16.27 years. All patients underwent surgical debridement and bone grafting using CV. Antibiotic therapy was tailored to the specific pathogens isolated in each case. Infection eradication was achieved in five patients. On average, new bone formation was 81% at six months and 99% at 12 months. Patient-reported outcome parameters (PROMs) utilizing the EQ-5D-5L questionnaire were recorded at a mean follow-up of 42.00 ± 27.97 months with a median EQ-5D-5L index of 0.541 (range: 0.459 - 0.97) and a mean EQ-5D-Visual Analogue Scale (VAS) score of 62.20 ± 24.68. No major adverse events related to CV were reported. Conclusion This retrospective case series demonstrates the potential efficacy of CV in managing FRIs. The bioactive and antibiotic properties of CV appear to facilitate infection resolution and bone healing, with an advantageous safety profile. Larger prospective studies are needed to further investigate the utility of CV in orthopedic practice.
PubMed: 38883114
DOI: 10.7759/cureus.60390 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Complex anatomy of the root canal system results in incomplete debridement with mechanical instrumentation, leaving some areas or root canal walls untouched. There comes...
INTRODUCTION
Complex anatomy of the root canal system results in incomplete debridement with mechanical instrumentation, leaving some areas or root canal walls untouched. There comes the significance of endodontic irrigants with residual antibacterial substantivity which prolongs the post-antibiotic effect, thereby improving the success and predictability of endodontic treatment.
AIM
To comparatively evaluate the residual antibacterial substantivity of 2% chlorhexidine, Biopure MTAD and 2% chitosan against at intervals of 1, 14 and 28 days.
MATERIALS AND METHODS
Seventy-five therapeutically extracted permanent single rooted mandibular premolars teeth were selected. Dentin blocks of 4 mm thickness were prepared and enlarged to 1.6 mm. The autoclaved blocks were inoculated with 24-hour colonies of pure cultures of for 14 days. After the contamination period, canals of each dentin block were irrigated with 5 ml of sterile saline and dried with sterile paper points. A total of 75 dentin blocks were randomly divided into five groups as follows: Group A (21 specimens): 2% chlorhexidine, Group B (21 specimens): Biopure MTAD, Group C (21 specimens): 2% chitosan, Group D (6 specimens): positive control (infected dentin tubes) and Group E (six specimens): negative control (sterile dentin tubes). Then, the lumens of dentin blocks were irrigated with the respective irrigants for 10 mins and were dried using sterile paper points. The specimens were then incubated at 37°C for 28 days to maintain humidity. At experimental intervals of 1, 14 and 28 days, dentin shavings were removed from the canals of respective groups by circumferential filing with sterile no. 35 Hedstrom files. The powdered dentin samples obtained with each dentin block were observed for colony forming units (CFUs) using a Digital Colony counter and were expressed as CFUs/mL.
RESULT
All the irrigants in the study showed a significant decrease in CFUs from day 1 to day 28 indicating that they have residual antibacterial substantivity against . Group B (Biopure MTAD) showed significantly least mean CFUs compared to Group A (2% CHX) and Group C (2% chitosan) against at B1(day 1), B2(day 14) and B3(day 28). Group A (2% CHX) showed significantly higher mean CFUs than Group C (2% chitosan) at A1(day 1). Group C (2% chitosan) showed significantly higher mean CFUs compared to Group A (2% CHX) at C2(day 14) and C3 (day 28).
CONCLUSION
MTAD showed statistically higher residual antibacterial substantivity against at experimental periods of 1, 14 and 28 days. The residual antibacterial effect of 2% chitosan was better compared to 2% CHX at day 1. The residual antimicrobial substantivity of 2% CHX was higher compared to 2% chitosan at intervals of 14 and 28 days.
PubMed: 38882860
DOI: 10.4103/jpbs.jpbs_693_23 -
Journal of Pharmacy & Bioallied Sciences Apr 2024This study aimed to conduct a human study to determine the incidence of postobturation pain using different parameters. In this cross-sectional study, 240 patients were...
Incidence of Postoperative Pain After Single- and Multiple-Visit Root Canal Treatment in Patients Reporting in the Conservative Dentistry and Endodontics Outpatient Department of a Tertiary Care Hospital: A Cross-Sectional Study.
This study aimed to conduct a human study to determine the incidence of postobturation pain using different parameters. In this cross-sectional study, 240 patients were included, which were equally allocated into two groups: single visit and multiple visit, 120 in each. Patients in both the single and multiple visits were further categorized into two subgroups, subgroup 1-no occlusal reduction and subgroup 2-occlusion reduction each having 60 patients. Corresponding to the type of visit, patients were followed by the role of medication into two groups, subgroup 1-both analgesics and antibiotics, subgroup 2-only analgesics, and subgroup 3-no medication. Following this approach and the criteria of the study, patients' performa was made, and based on this performa, the intensity of subjective symptoms, particularly postobturation pain, was determined using the visual analog scale (VAS). The data were then analyzed using the Chi-square test. Results were such that a single visit, no occlusal reduction, and only analgesics will be better for patients with irreversible pulpitis as chosen in the present study. Within the limitations of the present study, it can be concluded that single-sitting root canal treatment should be preferred over multiple sitting where there is no periapical inflammation; also, the occlusal reduction could be exempted from the same. To relieve the patient from postoperative pain where complete debridement is possible, antibiotics can be excluded from the regimen and only analgesics could be prescribed.
PubMed: 38882820
DOI: 10.4103/jpbs.jpbs_524_23 -
RSC Advances Jun 2024Post-extraction wound infections are a common complication of dental extractions. More specifically, infection in the alveolar socket after tooth extraction accelerates...
Post-extraction wound infections are a common complication of dental extractions. More specifically, infection in the alveolar socket after tooth extraction accelerates the resorption and destruction of the alveolar bone, and ultimately affects the final restoration results. Currently, the main clinical treatment approaches applied to the socket after tooth extraction include mechanical wound debridement, chemical rinses (, chlorhexidine), filling of the extraction socket with absorbent gelatin sponges, and the systemic application of antibiotics. However, these traditional treatment modalities have some limitations and their therapeutic effects are unsatisfactory. In this study, a phototherapeutic temperature-sensitive hydrogel material was constructed for injection using a tea polyphenol (TP)-modified poly--isopropylacrylamide (PNIPAM) hydrogel skeleton loaded with the photosensitiser indocyanine green (ICG). The resulting PNIPAM-TP/ICG system exhibited an excellent injectability and temperature-sensitive properties. In addition, it stopped haemorrhaging and acted as a wound astringent. The hydrogel steadily released ICG into the oral environment to exert photothermal/photodynamic effects along with synergistic antibacterial and anti-inflammatory properties when combined with tea polyphenols. experiments demonstrated that the application of PNIPAM-TP/ICG to infected dental extraction wounds in rats rapidly stopped the bleeding and accelerated wound healing. Overall, this study describes a drug-loaded, temperature-sensitive hydrogel for the treatment of open wound infections, and shows promise as a reference for the treatment of tooth extraction wounds.
PubMed: 38882475
DOI: 10.1039/d4ra03211j -
Journal of Orthopaedic Surgery and... Jun 2024Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to its insidious nature and potential for severe bone and soft tissue destruction. This systematic review and meta-analysis aims to review the literature on the treatment of chronic osteomyelitis in long bones and assess cure rates in single versus two-stage surgery.
METHODS
Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates.
RESULTS
The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases.
CONCLUSION
This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary.
Topics: Osteomyelitis; Humans; Chronic Disease; Adult; Treatment Outcome; Debridement
PubMed: 38877562
DOI: 10.1186/s13018-024-04832-7 -
International Journal of Surgery Case... Jul 2024Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical...
INTRODUCTION AND IMPORTANCE
Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical pelvic surgeries, with no established gold standard for surgical treatment. This case describes a rare anterior perineal hernia that developed after radical surgery for bladder carcinoma.
CASE PRESENTATION
A 77-year-old Caucasian woman presented with a painful 10 cm bulge in the perineal region. The hernial sac involved the entire left labia majora and developed 4 years after radical surgery for bladder carcinoma. She had been misdiagnosed twice in the past with vaginal prolapse, leading to two unsuccessful vaginoplasty procedures due to recurrence. She underwent hernia repair with perineal approach and polypropylene mesh placement. The postoperative period was uncomplicated, and the patient was discharged after five days, with histology showing no malignancy.
CLINICAL DISCUSSION
Perineal hernias are protrusions of intra- or extraperitoneal contents into the perineum due to a defect in the pelvic musculature. Various surgical modalities exist for perineal hernia repair, which adhere to the fundamental principles of hernia surgery: sac mobilization, precise incision, sac debridement and excision, and defect repair. Here, we successfully applied the perineal approach in a complicated case of a misdiagnosed perineal hernia after radical surgery.
CONCLUSION
The perineal approach for hernia repair, involving an implantation of a polypropylene mesh and tissue flap was successfully applied, confirming its main place in the surgical treatment of perineal hernias. During the two-year follow-up no postoperative complications or recurrence hernia were registered.
PubMed: 38875825
DOI: 10.1016/j.ijscr.2024.109859 -
Frontiers in Oral Health 2024Chronic periodontitis is a ubiquitous inflammatory disease in dental healthcare that is challenging to treat due to its impact on bone and tooth loss. Conventional... (Review)
Review
Chronic periodontitis is a ubiquitous inflammatory disease in dental healthcare that is challenging to treat due to its impact on bone and tooth loss. Conventional mechanical debridement has been challenging in eliminating complex subgingival biofilms. Hence, adjunctive approaches like low-level laser antimicrobial photodynamic therapy (A-PDT) utilising methylene blue (MB) have been emerging approaches in recent times. This review evaluates the latest research on the use of MB-mediated A-PDT to decrease microbial count and enhance clinical results in chronic periodontitis. Studies have shown the interaction between laser light and MB generates a phototoxic effect thereby, eliminating pathogenic bacteria within periodontal pockets. Moreover, numerous clinical trials have shown that A-PDT using MB can reduce probing depths, improve clinical attachment levels, and decrease bleeding during probing in comparison to traditional treatment approaches. Notably, A-PDT shows superior antibiotic resistance compared to conventional antibiotic treatments. In conclusion, the A-PDT using MB shows promise as an adjunctive treatment for chronic periodontitis. Additional research is required to standardize treatment protocols and assess long-term outcomes of A-PDT with MB in the treatment of periodontitis.
PubMed: 38872983
DOI: 10.3389/froh.2024.1407201 -
Open Forum Infectious Diseases Jun 2024Deep sternal wound infection is a rare complication of cardiac surgery that is typically caused by skin resident flora, such as species of and . Infections caused by...
Deep sternal wound infection is a rare complication of cardiac surgery that is typically caused by skin resident flora, such as species of and . Infections caused by fungi are less common and are generally caused by species. Regardless of etiology, these infections are associated with significant morbidity and mortality. We present a case of postoperative mediastinitis that occurred following a 5-vessel coronary artery bypass graft and was caused by a filamentous fungus of the genus. The patient was treated with serial debridement, liposomal amphotericin B, and isavuconazonium and was discharged from the hospital in stable condition. Fungal mediastinitis is a rare entity, and clinicians must maintain a high level of suspicion to make the diagnosis. A fungal cause of postoperative mediastinitis should be considered in patients with negative bacterial cultures, uncontrolled diabetes, or current immunosuppression or those who present weeks after surgery with a subacute onset of symptoms.
PubMed: 38872847
DOI: 10.1093/ofid/ofae302 -
Cureus May 2024Necrotizing fasciitis (NF) of the face is a rare yet serious condition requiring prompt and comprehensive management. This approach typically involves input from various...
Necrotizing fasciitis (NF) of the face is a rare yet serious condition requiring prompt and comprehensive management. This approach typically involves input from various medical specialties such as infectious disease specialists, critical care physicians, and surgeons. The primary goals are early recognition, aggressive surgical debridement, appropriate antibiotic therapy, and supportive care. Prompt diagnosis is crucial, based on symptoms like severe pain, rapidly spreading erythema, and systemic signs of infection. Broad-spectrum antibiotics are initiated empirically, and adjusted based on culture results. Urgent surgical debridement is crucial, removing all necrotic tissue. Careful consideration must be given to preserve vital structures. Close monitoring and intensive care may be necessary, especially for severe cases. Soft tissue reconstruction may follow once the infection is controlled, aiming to restore function and aesthetics. Long-term follow-up is essential to observe for complications and recurrence.
PubMed: 38872676
DOI: 10.7759/cureus.60278