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PubMed1998

[Treatment of deep neck infections].

BACKGROUND: The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons. PATIENTS: Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum. RESULTS: All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications. CONCLUSIONS: The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.

Abscess↗

PubMed1989

[Personal studies on the current spectrum of pathogenic bacteria in otitis externa and chronic otitis media].

From 1985-1987 smears (for Gram staining) and swabs (for culture and antibiogram) were done in 294 patients suffering from chronic otitis media, and in 67 cases of external otitis. Besides the comparison of these two procedures, the microbial spectrum in case of external otitis and chronic otitis media is considered and compared to the literature. Pseudomonas aeruginosa and Staphylococcus aureus are the most frequent pathogens. Often gram-positive rod-shaped bacilli were also found, the pathogenicity of which has been underestimated in the literature up to now. The anaerobes did not play an important role in our patients. The value of gram staining (immediate information and safer antibiotic therapy) is pointed out on the basis of the reported results.

Bacteria↗

PubMedDate not supplied

[Diagnosis and conservative therapy of cervical spondylitis].

We report diagnostic procedures and conservative therapy of eight patients suffering from unspecific bacterial cervical spondylitis. In three cases an infection of the craniocervical junction occurred. In addition to the clinical examination the diagnosis was made by the help of a serological examination, conventional radiographs, radioisotopes scannings and tomograms (CT and MRI). In all cases therapy was conservative because of absence of neurological symptoms. For immobilization a halo-west was used. Intravenous and oral antibiotics were applied according to antibiogram. In five cases an osseous fusion was achieved, six out of eight patients had no more complaints. The malposition of the concerned segment increased in one case, in a further case a post-arthritic arthrosis evolved.

Adult↗

PubMed1987

[Local treatment of infections in neurosurgery with gentamicin PMMA chains (Septopal)].

Treatment of infections after neurosurgical operations at the head and vertebral column is lengthy and stressful for the patient. Hence, we implanted--as has been routine in septic bone surgery for a long time--carriers of antibiotics for local antibiotic therapy in the form of Septopal chains. The course of treatment and the results obtained in 16 patients are presented. In all patients the wound cavities were filled with Septopal chains after débridement. In the course of 6-12 days the chains projecting from the skin by a stab incision were extracted sphere by sphere. The treated wound healed immediately in 14 patients; healing was delayed in 2 patients, but there were no complications. Since the use of Septopal chains results in local gentamicin levels which are so high that the conventional classification of germs into gentamicin-sensitive/gentamicin-resistant is of minor importance, the wounds healed without complications even in those patients where the germs had been classified as "resistant" in the routine antibiogram. Thus, Septopal offers the advantage of primary wound closure without secondary contamination or scatter into the environment (intensive-care ward!), shorter treatment time, reduced stress for the patient and more rapid mobilisation.

Adolescent↗

PubMed1981

[Renal tolerance of combined treatment with cefotaxime and gentamicin (author's transl)].

Treatment of 20 patients with 2 g cefotaxime intravenously and 80 mg gentamicin intramuscularly b.i.d. for various reasons before antibiograms were available showed no recognizable influence on renal function after one week. Patients were without renal disease and of both sexes on groups from 19-23, 36-59 and 63-69 years of age. No damage to the kidneys was evident when creatinine clearance, serum creatinine and urea concentrations and the usual urinalysis were considered.

Adult↗

PubMed2001

Antibiotic resistance patterns of group B streptococci in late third-trimester rectovaginal cultures.

OBJECTIVE: Our purpose was to determine the antibiotic sensitivity patterns of rectovaginal group B streptococcal isolates obtained from a heterogeneous obstetric population in the late third trimester. STUDY DESIGN: We performed a prospective observational study of rectovaginal group B streptococcal isolates obtained in the late third trimester during routine screening over a 12-month period. All cultures were prepared in a selective broth medium for 18 to 24 hours before plating onto sheep blood agar. Susceptibility testing of all isolates was performed for ampicillin, cefazolin, clindamycin, erythromycin, penicillin G, and vancomycin with the E-test method. RESULTS: A total of 2111 consecutive rectovaginal cultures were performed in which group B streptococci were isolated from 574 (27.2%) different patients. The "antibiogram" of the susceptible percentage is as follows: vancomycin, 100%; ampicillin, 98.2%; penicillin G, 98.2%; cefazolin, 98.1%; clindamycin, 92%; erythromycin, 81%. Ten isolates (1.8%) demonstrated intermediate susceptibility to both ampicillin and penicillin G. CONCLUSION: Routine susceptibility testing of group B streptococcal isolates collected during pregnancy should be considered because of the emergence of antibiotic resistance among group B streptococcal strains.

Adult↗

PubMed1998

Treatment of oroantral communications after tooth extraction. Is drainage into the nose necessary or not?

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.

Cephalosporins↗

PubMed2006

Antimicrobial drug utilisation in Dunedin Hospital, New Zealand, and its association with antimicrobial resistance.

INTRODUCTION: Antimicrobial resistance (AR) to a drug can be considered a natural response to the selection pressure of that drug, with over prescribing being one of the major causes. Few investigations have evaluated the relationships between antimicrobial drug use in a hospital and antimicrobial resistance. METHOD AND MATERIALS: Antimicrobial drug utilisation (AU) data were collated for Dunedin Hospital, New Zealand, and expressed as defined daily doses per 1000 patient days according to the World Health Organization's definition. The drug groups studied were glycopeptides, carbapenems, third and fourth generation cephalosporins and fluoroquinolones. Antibiograms were also analysed and possible associations between antimicrobial utilisation and resistance were investigated. The reduction of antimicrobial utilisation has also been explored by various means. RESULTS: The utilisation of fluoroquinolones at Dunedin Hospital was high compared with hospitals in South Australia, increasing from 1999 to 2003 then decreasing in 2004 and 2005. The Spearman rank correlation coefficients for the associations between fluoroquinolone utilisation and resistance to ciprofloxacin were: rs = 0.79, p = 0.06 for Pseudomonas aeruginosa and rs = -0.37, p = 0.5 for Escherichia coli. CONCLUSION: The findings of antimicrobial drug utilisation studies in hospital can serve to describe the pattern of drug use in the institution, to detect areas of concern, and to evaluate the impact of interventions taken to influence the use of drugs, especially when this use is associated with increasing antimicrobial drug resistance.

Anti-Bacterial Agents↗

PubMed2006

Analysis of genetic diversity among Staphylococcus aureus isolates from patients with deep-seated and superficial staphylococcal infections using pulsed-field gel electrophoresis.

Molecular typing was performed to reveal the genetic diversity among Staphylococcus aureus strains causing deep-seated versus superficial staphylococcal infections. Pulsed-field gel electrophoresis with cluster analysis, plasmid and antimicrobial susceptibility profiling of 50 S. aureus strains collected from these 2 groups of patients were undertaken. A total of 19 (designated A through S) distinct genotypes were identified by PFGE of Sma I-digested genomic DNA. The most prevalent PFGE type was L, which accounted for 30% of isolates and was detected among superficial isolates only. The second most prevalent PFGE type, type A (18%), was predominant among deep-seated isolates. Remaining PFGE types varied in distribution between the 2 groups. Plasmid profile analysis revealed that deep isolates harbour plasmids more frequently (comprising 64% of isolates) than superficial isolates (4%) and showed 10 and 2 distinct patterns, respectively, with pattern 1 being the dominant among deep isolates. Antimicrobial susceptibility data suggested an increased prevalence of antibiotic resistance among deep isolates with the majority (40%) exhibiting identical antibiograms compared to superficial isolates. No resistance was detected against clindamycin and vancomycin. The results of our study indicate a previously unrecognized dichotomy of S. aureus strains, causing deep-seated and superficial infections.

Adolescent↗

PubMed1998

Failure of pristinamycin treatment in a case of pneumonia caused by a streptogramins B-type resistant pneumococcus.

We report a failure of pristinamycin treatment in a case of pneumonia caused by streptogramins B-type resistant pneumococcus. We suggest that (i) streptogramins therapy should be avoided, if a previous treatment failure has been observed with a macrolide and/or if the antibiogram shows the MLS(B) co-resistance phenotype, and (ii) beta-lactams should remain the first-line antibiotics used for treatment of pneumococcal respiratory infections.

Aged↗

PubMed1999

Distribution of Acinetobacter baumannii in a neurointensive care unit.

In a 1-month prospective case-matched study we found Acinetobacter baumannii was a prevailing microbe simultaneously colonizing respiratory tract and skin of neurointensive care unit patients who stayed in our neurointensive care unit for more than 3 d. A. baumannii was not isolated from healthy case-matched controls. Based on their phenotypic properties and the results of amplified ribosomal DNA restriction analysis the 12 strains of Acinetobacter spp. isolated were identified as belonging to DNA group 2 (A. baumannii). For epidemiological typing, Biolog system results of 95-carbon source oxidation, antibiograms and restriction endonuclease analysis were used. One predominant A. baumannii strain was found in all colonized patients, skin and respiratory tract were found mainly to be colonized with the same strain. The starting point of A. baumannii colonization seemed to vary with the individual patient. Environmental strains were different from patients' strains: they were metabolically more active, more resistant and had a different restriction endonuclease analysis profile.

Acinetobacter↗

PubMed2005

Persistent and intractable ventriculitis due to retained ventricular catheters.

It is generally recommended that, in cases of difficulty in removing a ventricular catheter during a shunt revision, it is best left alone to avoid intraventricular haemorrhage. Retained ventricular catheters (RVCs) are usually safe, although in the presence of ventriculitis they may become colonized by organisms and become a source of persistent or recurrent infection. The authors present a case of persistent and intractable ventriculitis due to an old retained ventricular catheter. A 23-year-old female, who had a RVC and a functioning shunt, was admitted for a suspected blocked shunt. At surgery the shunt was found to be infected and external drainage was instituted. Over the next 4 months, she developed intractable and persistent staphylococcal ventriculitis, despite undergoing 10 further surgical procedures, and appropriate intravenous and intrathecal antibiotic therapy. She responded rapidly only after surgical removal of the old RVC via a craniotomy. The staphylococcus cultured from the RVC had an identical antibiogram to the organism responsible for the intractable ventriculitis. This case emphasizes the point that, although RVC are generally considered safe, removal becomes imperative in the presence of concurrent CSF infection that fails to respond quickly to intrathecal antibiotic therapy.

Adult↗

PubMed2002

Ureaplasma urealyticum as a possible cause of reflex sympathetic dystrophy syndrome.

We describe the cases of two patients with clinical and radiological findings of the reflex sympathetic dystrophy syndrome (RSDS) in whom the history of a previous genito-urinary inflammation and high levels of ESR lead us to suspect a hidden reactive arthritis. However, instrumental examinations showed a characteristic picture of RSDS without evident signs of arthritis. In both patients we decided a treatment with quinolones because of detection of an ureaplasma urealyticum genito-urinary infection. This brought to complete remission of the joint symptoms in a few days. Our findings suggest that ureaplasma urealyticum can cause and sustain a RSDS picture, maybe with a reactive arthritis-like mechanism, and that an antibiogram-driven antimicrobial treatment can be rapidly effective against this disorder.

Adult↗

PubMed2001

Verotoxin-producing Escherichia coli--an environment-induced emerging zoonosis in and around Calcutta.

With changes in livestock management practices and food processing industry, along with changes in people's food habits, many diseases have emerged. Infection with verotoxin-producing Escherichia coli (VTEC) is one such illness. In the present study an attempt was made to isolate, identify and characterize VTEC strains with reference to the O157:H7 serotype from animal, human sources and some food products with the aid of the available modern methods. A total of 876 samples (330 animal, 184 human, 362 food samples) were screened for the presence of VTEC by conventional as well as PCR technique. Seventeen VTEC strains (12 animal, one human and four food samples) were isolated. The isolation rate was higher in diarrhoeic animals (6.02%), followed by diarrhoeic handler (3.12%) and raw beef (1.78%) samples. All strains showed the presence of the VT gene by PCR tests and were uniformly sensitive to common antibiotics except tetracycline, cephalexin, dicloxacillin, erythromycin and lincomycin. Since all strains were isolated from various sources of animal and human origin and all strains showed the presence of the VT gene and uniform antibiogram, a zoonotic association is suggested. This study marks the first report of isolation of VTEC strains from animal sources in India.

Animals↗

PubMed2005

Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs.

Fusobacterium necrophorum, an anaerobic, Gram-negative rod, has been identified recently as a significant cause of persistent sore throat syndrome (PSTS). This disease is characterised by chronic, recurrent or persistent sore throat, which is believed to respond poorly to penicillin in vivo. The aim of this study is to examine the prevalence of F. necrophorum in all throat swabs received in our diagnostic microbiology department and to compare the results with those for other recognised respiratory pathogens. All throat swabs received in the laboratory over a four-week period were cultured for beta-haemolytic streptococcus groups A, C and G, Corynebacterium diphtheriae, Arcanobacterium haemolyticum and F. necrophorum. Latex agglutination techniques, phenotypic reactions and antibiograms are used to identify these organisms. The age of the patient and the clinical details as stated on the request form were noted. Among a total of 248 samples, 27 were positive for beta-haemolytic streptococcus group A, two were positive for beta-haemolytic streptococcus group C, five were positive for beta-haemolytic streptococcus group G and 24 were positive for F. necrophorum. The most common isolate in the under 20 age group was beta-haemolytic streptococcus group A. In the over 20 age group, F. necrophorum was the pathogen most frequently isolated. A clinical diagnosis of 'sore throat' was most likely to be positive for beta-haemolytic streptococcus group A, a clinical diagnosis of PSTS was most likely to be positive for F. necrophorum and a clinical diagnosis of 'tonsillitis' was equally likely to be caused by beta-haemolytic streptococcus group A or F. necrophorum. beta-haemolytic streptococcus group A was present in 11% of the samples and F. necrophorum was present in 10% of the samples. In total, these two pathogens accounted for 18.5% of throat infections in the sampled group. The results show that F. necrophorum is as significant a cause of throat infection as is beta-haemolytic streptococcus group A. Examination of this provisional data suggests that targeting culture towards these two pathogens may be possible in certain cohorts of patients if more precise clinical data are received from medical staff. However, based on the clinical symptoms routinely provided by clinicians requesting microscopy, culture and sensitivity on throat swabs, F. necrophorum culture is required on all throat swabs received in the laboratory.

Actinomycetaceae↗

PubMed2026

Four-year surveillance of major Gram-negative pathogens in a Saudi tertiary hospital: clinical distribution, comorbidity profiles, and antimicrobial resistance.

PURPOSE: To describe four-year diagnostic-distribution, burden, and antimicrobial-resistances of major Enterobacterales and Pseudomonas aeruginosa in a tertiary-care surveillance framework. PATIENTS AND METHODS: We retrospectively studied first non-duplicate-isolate per/patient/organism between 2022-2025 at a Saudi tertiary-care. Diagnostics used automated-platforms with GeneXpert-Carba-R employed parallel to cultures. Susceptibility interpretations used CLSI-breakpoints relevant to test-year. Annual-trends were assessed with grouped-binomial logistic-regression, and Benjamini-Hochberg false-discovery-rate correction was applied within prespecified analysis. RESULTS: Among 1,857 isolates, Klebsiella pneumoniae was most frequent (36.2%), followed by P. aeruginosa (33.4%), Escherichia coli (17.9%), and Enterobacter cloacae (12.3%). Mean patient age was 64.8 years, 51.3% isolates were from intensive-care, 37.4% from urine, and 80.8% records had comorbidity. K. pneumoniae showed overall ESBL (76.6%), CRE (59.9%), MDR (69.3%), panel-defined XDR (64.7%), and panel-defined PDR (15.2%) frequencies. Enterobacterales ESBL-positivity increased (58.1% to 76.8%;q <0.001), whereas meropenem non-susceptibility decreased (52.6% to 33.2%;q <0.001). In P. aeruginosa, ceftazidime non-susceptibility increased (55.2% to 78.6%;q <0.001), meropenem decreased (46.8% to 32.9%;q = 0.031), and tobramycin increased (22.2% to 45.7%;q = 0.030). Crude-comorbidity differences remained insignificant after false-discovery-rate correction. CONCLUSION: We show a persistent species-specific Gram-negative resistance burden, led by K. pneumoniae and accompanied by substantial P. aeruginosa non-susceptibility. This supports organism-specific detections, antibiograms and continued multicenter-surveillance linked to antimicrobial exposure, genomic-data, and patient outcomes.

ESBL↗

PubMed1996

[Tuberculosis: multidrug-resistance in Belgium in 1992 and 1993].

The "Belgian TB Multidrug Resistance Working Group" determined in collaboration with 28 laboratories carrying out antibiograms for mycobacteria, the prevalence and incidence of multidrug resistance in Belgium in 1992-1993. During this period, respectively 14 (1.1%) and 17 (1.3%) cases of multidrug resistance (i.e. resistance to at least isoniazid and rifampicin, according to the W.H.O. definition), were detected by these laboratories. Since 9 new cases of multidrug resistance were detected in 1992 and 10 in 1993, the incidence of multidrug resistance in Belgium can be estimated at 0.1 per 100.000 inhabitants. Among these 19 new cases, 2 are confirmed as primary resistance cases.

Adolescent↗

PubMed2000

Polyclonal Staphylococcal endocarditis caused by genetic variability.

Cultures of blood obtained from a patient with Staphylococcus epidermidis prosthetic valve endocarditis yielded 15 strains of S. epidermidis. Genome macrorestriction and amplified fragment-length polymorphism analyses of these strains showed that they belonged to 4 different, very closely related clones, suggesting that they were the result of genetic variability of an infecting strain during the infectious episode. In vivo experiments in a rat model for foreign body infections using 1 of the S. epidermidis strains from the patient showed genetic variability similar to that of the infecting strain. In the rat model, we also detected the simultaneous presence of different clones that were identical to those isolated from our patient, thus confirming the possibility of genetic variability. It is important to note that the 4 clones isolated from our patient presented with 2 different antibiograms. Therefore, in cases of foreign device-related infections due to coagulase-negative staphylococci, the possibility of polyclonal infection has to be taken into account, particularly as regards differences in antibiotic susceptibility.

Aged↗