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International Journal of Surgery Case... Apr 2024Clavicular osteomyelitis, unlike the metaphysis of long bones, is a rare condition that poses a challenge for orthopedic surgeons in terms of diagnosis. The unique...
INTRODUCTION AND IMPORTANCE
Clavicular osteomyelitis, unlike the metaphysis of long bones, is a rare condition that poses a challenge for orthopedic surgeons in terms of diagnosis. The unique location of the clavicle makes it crucial to diagnose and effectively manage these non-traumatic clavicular lesions promptly. Localized pain and swelling are common symptoms experienced by patients with clavicular osteomyelitis.
CASE PRESENTATION
A 9-year-old boy presented with swelling and pain in the left clavicular area for 6 months. There was no fever or history of trauma. Physical examination revealed a tender, 2 cm by 3 cm swelling over the left clavicular area, with no abnormal findings in other body systems. This case was treated with surgical debridement and PO cloxacillin, and his condition improved.
CLINICAL DISCUSSION
To achieve an accurate diagnosis, a thorough analysis of the patient's clinical presentation, along with blood workups, radiologic studies, bacteriological studies, and histopathological studies, is essential. Treatment options for clavicular osteomyelitis may involve surgery, medical intervention, or a combination of both. Existing literature suggests that the cure rate does not significantly differ between patients who receive medical treatment and those who undergo surgery for clavicular osteomyelitis.
CONCLUSION
In evaluating non-traumatic clavicular lesions, considering chronic osteomyelitis as a potential diagnosis is important. The final diagnosis is determined through analysis of the clinical presentation, laboratory and radiographic tests, and confirmation with assistance from local culture and biopsy.
PubMed: 38810297
DOI: 10.1016/j.ijscr.2024.109667 -
Journal of Dairy Science May 2024The present study demonstrates successful herd sanitation and eradication of contagious mastitis caused by Staphylococcus aureus genotype B (S. aureus GTB) in an entire...
The present study demonstrates successful herd sanitation and eradication of contagious mastitis caused by Staphylococcus aureus genotype B (S. aureus GTB) in an entire Swiss district (Ticino) including 3,364 dairy cows from 168 farms. Herd sanitation included testing of all cows using a highly GTB specific and sensitive qPCR assay, implementation of related on-farm measures, appropriate antibiotic therapy of GTB-positive cows and culling of therapy-resistant animals, respectively. A treatment index was used as an objective criterion to select GTB-positive cows eligible for culling and replacement payment. 62 herds (37%) were initially GTB-positive with a cow prevalence between 10% and 100% and were submitted to sanitation. Twenty mo after the start of the campaign, all these herds were free from S. aureus GTB, whereby 73% of them were sanitized during the first 7 mo. At the cow level, a total of 343 animals were infected. 50 of them were immediately culled and financially compensated based on their treatment index value The remaining 293 cows were intramammarily treated with antibiotics either during lactation using the combination of cephalexin-kanamycin or penicillin-gentamicin or at dry-off using cloxacillin. Out of these cows, 275 (93.9%) were treated successfully meaning that their milk was twice GTB-negative by qPCR after therapy. For lactational treatment, control samples were taken ≥10 and ≥20 d after treatment, for dry off treatment ≥14 and ≥24 d after parturition. Neither lactation number nor SCC before treatment of the cow nor the type of therapy were associated with therapeutic cure. Using data of 30 GTB-positive and 71 GTB-negative herds (1855 observations), the impact of GTB sanitation on bulk tank milk SCC (BTSCC) was evaluated applying a linear mixed statistical model. In the year before sanitation, BTSCC was always higher in GTB positive than in GTB negative herds. After the start of the campaign, BTSCC declined rapidly in the herds under GTB sanitation and achieved values that no longer differed statistically from those of GTB-free herds after only 2 mo, remaining very similar for the rest of the campaign. The farmers were very satisfied with the outcome of the campaign as all GTB positive herds could be sanitized rapidly, sanitation was sustainable, and milk quality increased.
PubMed: 38788844
DOI: 10.3168/jds.2023-24245 -
Cureus Apr 2024Introduction Individuals with sickle cell disease (SCD) are particularly vulnerable to urinary tract infections (UTIs) due to immunological deficits and renal...
Introduction Individuals with sickle cell disease (SCD) are particularly vulnerable to urinary tract infections (UTIs) due to immunological deficits and renal abnormalities associated with the disorder. These infections can exacerbate underlying health issues and lead to severe complications if not managed promptly and effectively. Due to the heightened risk and potential consequences of UTIs in this population, this study aimed to determine their prevalence and explore the resistance patterns of causative pathogens among children attending the SCD Clinic at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Focusing on this demographic group, we sought to provide targeted insights to inform better clinical protocols and intervention strategies in regions heavily affected by SCD. Materials and methods This prospective cross-sectional study was conducted at the MNH, Dar es Salaam, Tanzania, with an enrollment over two months from 19 March to 21 May 2015. We diagnosed UTIs in children with SCD using dipstick and culture methods. Antibiotic susceptibility was assessed using the Kirby-Bauer disc diffusion method, evaluating resistance patterns to antibiotics such as ampicillin, cloxacillin, erythromycin, chloramphenicol, ceftriaxone, and trimethoprim-sulfamethoxazole. The diagnostic accuracy of the dipstick and culture methods was validated to ensure reliability in detecting UTIs. Statistical analysis was conducted using Statistical Product and Service Solutions (SPSS) software (Released 2019; IBM Corp., Armonk, New York, United States). Results Among the 250 children, 56 (22.4%) were UTI-positive according to the culture method and 62 (24.8%) were UTI-positive according to the dipstick test. Girls were more likely to be UTI-positive than boys (29.1% and 13.6%, respectively; p-value = 0.011). was the most common uropathogen, followed by and (44.2%, 26.9%, 21.2%, 3.8%, and 1.9%, respectively). All isolates were resistant to ampiclox. Resistance rates to ampicillin, erythromycin, cotrimoxazole, chloramphenicol, and ceftriaxone were 94.2%, 76.9%, 59.6%, 46.2%, and 21.2%, respectively. Conclusion This study indicated that dipsticks diagnosed more UTIs. The prevalence was higher in girls than in boys. was the most commonly isolated antibiotic-resistant organism. High resistance levels were observed against the combination of ampicillin and cloxacillin. However,the isolates were less resistant to ceftriaxone. These results call for increased surveillance of resistant uropathogens in the pediatric population with SCD.
PubMed: 38784373
DOI: 10.7759/cureus.58786 -
Diagnostic Microbiology and Infectious... May 2024Plasmid-encoded DHA-type AmpCs have been extensively reported in Enterobacterales. The expression of the genes encoding these plasmid-mediated enzymes are inducible and...
Plasmid-encoded DHA-type AmpCs have been extensively reported in Enterobacterales. The expression of the genes encoding these plasmid-mediated enzymes are inducible and these enzymes are capable of conferring resistance to a wide spectrum of beta-lactams including penicillins and broad-spectrum cephalosporins. The identification of infections caused by AmpC-producing bacteria is a necessity, both for infection control/epidemiology purposes and to inform treatment choices. A common testing method for AmpC production in the clinical laboratory setting is to supplement Mueller-Hinton agar plates used for antibiotic disk diffusion with cloxacillin, a potent inhibitor of AmpC enzymes. Here we describe a novel DHA variant, produced by a clinical Escherichia coli isolate, which is resistant to cloxacillin inhibition.
PubMed: 38763036
DOI: 10.1016/j.diagmicrobio.2024.116356 -
Antimicrobial Agents and Chemotherapy May 2024Gentamicin is widely used to treat neonatal infections caused by both Gram-negative and Gram-positive bacteria, and the WHO recommends its use while monitoring serum...
Gentamicin is widely used to treat neonatal infections caused by both Gram-negative and Gram-positive bacteria, and the WHO recommends its use while monitoring serum creatinine and gentamicin concentrations to avoid drug-induced nephrotoxicity and ototoxicity. Yet in some resource-limited settings, the drug is used without monitoring. A population pharmacokinetics study involving term neonates with neonatal infection admitted to a neonatal unit. Participants were started on intravenous gentamicin 5 mg/kg once a day in combination with ampicilin-cloxacillin. Blood samples for serum gentamicin concentration were taken at 0.25, 0.5, 1, 2, 3, 5, 6, 8, 10, 12, 14, 16, 18, 20, 23, and 24 hours after the initial dose, each participant contributing two samples to the 24 hour sampling schedule. An additional sample for trough concentration was taken from each participant just before the third gentamicin dose while serum creatinine concentration was measured before and after treatment. Twenty-four participants were enrolled into the study and included in the final analysis. Mean (SD) peak and trough serum gentamicin concentrations were 16.66 (0.64) µg/mL and 3.28 (0.70) µg/mL, respectively. Gentamicin clearance (CL) was 0.40 mL min kg and volume of distribution (VD) was 0.31 L kg. Mean (SD) serum creatinine level after treatment was 209.7 (70.4) µmol/L compared to 103.3 (23.6) µmol/L before treatment [mean difference (106.4 ± 67.1; 95% confidence interval (CI): 78.1; 134.7 µmol/L; t (23) = 7.77; < 0.001]. All participants fulfilled the Kidney Disease Improving Global Outcomes (KDIGO) criteria for acute kidney injury after treatment. Treatment of neonatal infection with antimicrobial regimen containing gentamicin, without renal function and gentamicin concentration monitoring, carries a significant risk for drug-induced acute kidney injury.
PubMed: 38747600
DOI: 10.1128/aac.01495-23 -
Food Science & Nutrition May 2024In this study, to investigate spp. contamination post-scalding and de-feathering, post-evisceration, post-chilling, and packaged products, which are the most essential...
In this study, to investigate spp. contamination post-scalding and de-feathering, post-evisceration, post-chilling, and packaged products, which are the most essential contamination stages of broiler slaughter, a total of 108 samples were taken from three different broiler slaughterhouses at different times. Isolates obtained by cultural methods in 104 of 108 samples were analyzed by mPCR method to identify pathogen spp. , , and mixed contamination of both species were detected in 51 samples. Of the 51 isolates, 27 (52.9%) were , 16 (31.4%) were , and 8 (15.7%) were mixed contamination of and , while was not detected. and contamination was 59.2% post-scalding and de-feathering, 43.4% post-evisceration, 44.4% and 48.1% post-chilling and in packaged products, respectively. All strains were found to be 100% resistant to cefoperazone and penicillin and sensitive to tetracycline. strains were 100% resistant to cefoperazone, penicillin, and cloxacillin and susceptible to tetracycline and erythromycin. In the study, it was determined that spp. caused a very intense contamination (85.18%-100%) and also contamination rates of identified pathogen strains ( and ) were very high (59.2% and 43.4%) in broiler slaughtering stages. Considering that each step in broiler slaughter could contaminate the next stage, developing a safe slaughter and minimizing the risk toward the final product, it was concluded that critical control points could not be well managed in broiler slaughterhouses, and broiler meat may pose a significant risk to public health.
PubMed: 38726459
DOI: 10.1002/fsn3.4013 -
Southern African Journal of Infectious... 2024Necrotising fasciitis (NF) is a fulminant soft tissue infection that requires timely diagnosis, urgent surgical debridement, and appropriate antimicrobial therapy. The...
BACKGROUND
Necrotising fasciitis (NF) is a fulminant soft tissue infection that requires timely diagnosis, urgent surgical debridement, and appropriate antimicrobial therapy. The choice of empiric antimicrobial therapy depends on the microorganisms cultured and the antimicrobial resistance profile of the institution. Necrotising fasciitis has not been studied in our setting.
OBJECTIVES
The aim of the study was to audit the microbiological profile of NF and antimicrobial susceptibility profile.
METHOD
This was a retrospective study in a secondary level hospital from the period of 2014-2020. The patients' demographic data, clinical features, location of infection, comorbidities, laboratory and microbiological profiles were analysed.
RESULTS
There were 53 patients during 2014-2020 with median age of 45.5 (38.5-56.0) years. The majority of the patients were males (35 [66.04%]), had no comorbidities (25 [47.17%]), and the lower limb was the most common anatomic site (17 [32.08%]). Type II (monomicrobial) NF was the predominant type (31 [58.49%]). was the most prevalent Gram-positive bacteria (18 [38%]) and the main species isolated in the Gram-negative bacteria (14 [36%]) with susceptibility to cloxacillin (94%) and amoxicillin and/or clavulanic acid (92%), respectively.
CONCLUSION
and were the most common bacteria with low rate of antimicrobial resistance. Amoxicillin and/or clavulanic acid and an adjunctive clindamycin are appropriate antimicrobial therapy for empiric treatment for NF in our setting.
CONTRIBUTION
Amoxicillin and/or clavulanic acid and an adjunctive clindamycin can be used as an empiric treatment for NF.
PubMed: 38726018
DOI: 10.4102/sajid.v39i1.542 -
Global Spine Journal May 2024Prognostic study.
STUDY DESIGN
Prognostic study.
OBJECTIVES
The objective of this study is to identify predictive factors for cloxacillin susceptibility in spinal infections.
METHODS
A retrospective analysis was conducted using data from January 1, 1997, to December 31, 2021. The study included patients presenting with back pain and either a positive bacterial culture from the spine or radiological evidence of spinal infection (spondylodiscitis and/or epidural abscess) along with positive bacterial blood culture.
RESULTS
Among 171 patients (127 males, 44 females), 53.2% had isolates, with 40.4% showing cloxacillin resistance. Lower globulin levels (<33.5 g/L), recent hospitalization within 90 days, and residence in an old age home predicted gram-positive bacteria with cloxacillin resistance and gram-negative bacteria as causative organisms (<.05). The 30-day and 1-year all-cause mortality rates were 0% and 8.2%, respectively. Higher red cell distribution width (RDW >16.1%) and Charlson comorbidity index (CCI) scores predicted 1-year all-cause mortality (<.05). Intensive care unit admission was required for 9.9% of patients.
CONCLUSIONS
This study identified predictive factors for spinal infection by gram-positive bacteria with cloxacillin resistance and gram-negative bacteria. Patients with lower globulin levels (<33.5 g/L), recent hospitalization within 90 days, or residency in an old age home upon admission should avoid standalone cloxacillin therapy and consider antibiotics with gram-negative coverage. Higher RDW (>16.1%) and CCI scores were associated with increased 1-year all-cause mortality. These findings contribute to treatment decision-making and improving patient outcomes in spinal infections.
PubMed: 38710111
DOI: 10.1177/21925682241251814 -
Frontiers in Public Health 2024Severe acute malnutrition is a threat to child survival as mortality rates in children with severe malnutrition are nine times higher. Globally, about 19 million...
BACKGROUND AND AIM
Severe acute malnutrition is a threat to child survival as mortality rates in children with severe malnutrition are nine times higher. Globally, about 19 million children are severely malnourished. This study looked at children aged 6-59 months admitted to hospital to see how quickly they recovered from severe acute malnutrition as well as what factors predicted their recovery.
METHODS
The study included 543 systematically chosen children with severe acute malnutrition who were admitted to the stabilization center of a hospital. Data from the patient registry were gathered using a retrospective follow-up study design. In order to find predictors of recovery, the Cox proportional hazard model was applied.
RESULTS
From 543 children, 425 (78.27%) were recovered. The median survival time was 8 days. Having grade II edema, grade III edema, and pneumonia were negatively associated with recovery. Similarly, taking ceftriaxone, cloxacillin, and being on a nasogastric tube were associated with poor recovery. Conversely, better recovery rates were linked to exclusive breastfeeding and vitamin A supplementation.
CONCLUSION
Both the recovery rate and the median survival time fell within acceptable bounds. To boost the recovery rate, efforts are needed to lessen comorbidities.
Topics: Humans; Infant; Female; Male; Severe Acute Malnutrition; Child, Preschool; Retrospective Studies; Hospitalization; Proportional Hazards Models; Follow-Up Studies
PubMed: 38706552
DOI: 10.3389/fpubh.2024.1258647 -
The Malaysian Journal of Pathology Apr 2024Beta-lactamase producing bacterial infection has been on surge due to selection pressure and injudicious antibiotics usage. Organisms that co-produced more than one beta...
INTRODUCTION
Beta-lactamase producing bacterial infection has been on surge due to selection pressure and injudicious antibiotics usage. Organisms that co-produced more than one beta lactamase enzyme posed diagnostic challenges which may result in inadequate treatment. To date, there is no standardised guideline offering phenotypic detection of AmpC β-lactamase. The purpose of this study was to determine the prevalence of ESBLs, AmpC β-lactamase and co-producer organisms in a teaching hospital.
MATERIALS AND METHODS
Three hundred and four isolates of E. coli and Klebsiella sp. had been selected via convenient sampling. These isolates were identified using conventional laboratory methods and their antimicrobial susceptibilities were determined using disc diffusion method. Those isolates were then proceeded with ESBL confirmatory test, cloxacillin-containing Muller Hinton confirmatory test, modified double disk synergy test and AmpC disk test.
RESULTS
Out of 304 isolates, 159 isolates were E. coli and 145 were Klebsiella sp. The prevalence of organisms which co-produced AmpC β-lactamase and ESBL enzymes were 3.0%. Besides that, 39 cefoxitin resistant and three cefoxitin susceptible isolates (13.8%) were proven to produce AmpC β-lactamase through AmpC disk test. Through the CLSI confirmatory test, 252 (82.9%) isolates were identified as ESBLs producers and the prevalence increased slightly when cloxacillin-containing Muller Hinton were used. Only three ESBLs positive organisms were positive for modified double disk synergy test.
CONCLUSION
Distinguishing between AmpC β-lactamase and ESBL-producing organisms has epidemiological significance as well as therapeutic importance. Moreover, AmpC β-lactamase and ESBLs co-producing organisms can lead to false negative ESBL confirmatory test. Therefore, knowing the local prevalence can guide the clinician in navigating the treatment.
Topics: Humans; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Escherichia coli; Escherichia coli Infections; Hospitals, Teaching; Klebsiella; Klebsiella Infections; Microbial Sensitivity Tests; Prevalence; Cross Infection
PubMed: 38682847
DOI: No ID Found