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Contained rupture of the aneurysm of common iliac artery associated with pyogenic vertebral spondylitis.

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of contained rupture of the aneurysm of common iliac artery associated with pyogenic vertebral spondylitis, so that investigators and practitioners may avoid the diagnostic and therapeutic pitfalls associated with pyogenic vertebral spondylitis and aortic disease. SUMMARY OF BACKGROUND DATA: Pyogenic vertebral spondylitis is a rare disorder that may have serious consequences, including death, if it is not diagnosed promptly and treated effectively. The association of pyogenic vertebral spondylitis with infection of the aorta is a rare but potentially fatal condition that requires prompt diagnosis and aggressive surgical and medical therapy. To our knowledge, this is the first report of a contained rupture of the aneurysm of common iliac artery case associated with pyogenic vertebral spondylitis resulting from an infection with Bacteroides fragilis,although Salmonellae infections are commonly associated with vertebral osteomyelitis and lesions of the contiguous aorta. METHODS: A 60-year-old man with chronic lower back pain began to experience a severe pain and had increased difficulty in walking. An MRI scan showed an increased signal in the L4-L5 disc space and an abscess extending into the spinal canal. The presumptive diagnosis was infective spondylitis. While performing a CT-guided needle biopsy, an unexpected contained rupture of the aneurysm of common iliac artery was discovered. RESULTS: A wide resection of all infected tissue, including the right common iliac artery and bony lesions, was performed in combination with antimicrobial therapy. A cryopreserved aortic allograft was used to reconstruct the artery, and an iliac strut graft was used to fill the debrided vertebral cavity. The patient's postoperative recovery was uneventful. CONCLUSION: The coexistence of pyogenic vertebral spondylitis and lesions of the aorta is rare, but may be lethal if not diagnosed promptly and treated effectively. Even if a patient's condition is stable and the hematocrit is normal, it is important to consider the possibility of a contained rupture of a mycotic abdominal aneurysm in all patients with vertebral osteomyelitis who have acute episodes of unusual severe back pain. CT is sometimes more beneficial than MRI in the identification and characterization of contained rupture of aneurysms.

Aneurysm, Ruptured↗

Therapeutic effects of an injectable new quinolone, pazufloxacin, against polymicrobial infections in the uterine endometritis model.

Polymicrobial infections with aerobes and anaerobes are common in female genital tract infections. We evaluated the efficacy of an injectable new quinolon, pazufloxacin, using a uterine endometritis model. Rats were infected with a mixed inoculation of Escherichia coli plus Bacteriodes fragilis (MIC of pazufloxacin and ceftazidime: E. coli: 0.05 and 1.56 micrograms/ml, respectively, B. fragilis: 3.13 and 3.13 micrograms/ml, respectively). After inoculating 10(7) cfu/rat of each organism, pazufloxacin or ceftazidime (10 or 20 mg/kg, respectively, i.v., b.i.d., 3 days) was administered and compared with the nontreated group. The viable cell counts of the uterine corpus and uterine cervix in pazufloxacin-treated and ceftazidime-treated groups were decreased, compared with the nontreated group. The viable cell counts of the adnexa in the pazufloxacin-treated group were significantly decreased, compared with the ceftazidimetreated group. These results suggest that pazufloxacin would be useful for the treatment of polymicrobial infections, especially adnexitis.

Animals↗

Taxonomy, virulence and epidemiology of black-pigmented Bacteroides species in relation to oral infections.

Black-pigmented Bacteroides species are recognized as suspected pathogens of oral infections. Developments in the taxonomy of this group include description of a new asaccharolytic species, Bacteroides salivosus, and proposal for the reclassification of the asaccharolytic species into a separate genus, Porphyromonas. Studies on the pathogenicity and virulence of black-pigmented Bacteroides species have identified Bacteroides gingivalis as the most virulent species. B. gingivalis and Bacteroides intermedius have been associated with periodontal diseases; Bacteroides endodontalis is isolated specifically from infections in the oral cavity, and other black-pigmented Bacteroides species are recovered from oral mucous sites. DNA restriction endonuclease analysis was adapted for typing of B. gingivalis and B. intermedius.

Bacteroides↗

Synergistic lethality in experimental infections with Escherichia coli and Bacteroides fragilis.

Using an animal model, a synergism in lethality of infections with Escherichia coli and Bacteroides fragilis is described. This synergism was dependent on certain dosage combinations of the infectious agents. It was demonstrated that animal-passaged, laboratory-passaged, and heat-killed B. fragilis alike were capable of producing this synergism. However, animal-passaged B. fragilis showed superior recovery rates from animal organs.

Animals↗

Bacteroides fragilis bacteremia and infected aortic aneurysm presenting as fever of unknown origin: diagnostic delay without routine anaerobic blood cultures.

We report the case of a 71-year-old male with Bacteroides fragilis bactermia and infected aortic aneurysm that went undiagnosed, in part, because routine anaerobic blood cultures were not obtained. Bacteremia caused by anaerobes has been reported to be declining, and recommendations to discontinue routine anaerobic blood cultures have been implemented in some hospitals. To our knowledge, this is the first report of an anaerobic bacteremia and infection that had a delay in diagnosis due to this change in blood-culturing protocol. The potential impact of deleting anaerobic blood cultures from routine protocols is discussed.

Aged↗

Aspects on antibacterial treatment of anaerobic infections.

A review is given of current antibiotic treatment of anaerobic infections. It is emphasized that infections with Bacteroides fragilis constitute the main problem, virtually all other anaerobe organisms of clinical significance are sensitive to penicillin. Particularly useful antibiotics for infections with B. fragilis are cefoxitin, chloramphenicol, clindamycin and the nitroimidazoles. Vancomycin is the drug of choice for pseudomembranous colitis provoked by Clostridium difficile.

Anaerobiosis↗

Fatal colitis in a hemophilic patient with inhibitor.

A severe colitis developed in a hemophilic patient following an antibiotic regimen which included clindamycin. A surgical procedure, total hip replacement, had been complicated by the appearance of a powerful factor VIII inhibitor and a Bacteroides fragilis infection. The resulting bleeding diathesis was successfully managed with the use of an "activated prothrombin complex"; however, the occurrence of colitis following intravenous clindamycin therapy proved to be fatal. Clindamycin, like the related antibiotic lincomycin, appears to have significant intestinal toxicity and should be restricted to the treatment of life-threatening proven Bacteroides infections.

Adult↗

[Intraabdominal polymicrobial infection due to antimicrobial resistant anaerobes].

Successful treatment of surgical infections includes both the implementation of careful operative technique and the choice of appropriate antimicrobial agent. Because of advances in the techniques used for anaerobic specimen collection and culture, anaerobic bacteria are now predominantly recovered from a variety of intra-abdominal and post-operative soft tissue infection. Furthermore, some anaerobes including Bacteroides and Prevotella, like some aerobic bacteria, have acquired resistance to the commonly used antimicrobial agent. The underestimation of resistant anaerobes other than Bacteroides in infective sites may lead to incorrect choices of antimicrobial agent for empirical therapy and thus to clinical failures of therapy. Surgeons should be more interested in the polymicrobial infecting flora to improve the clinical outcome of such infections.

Anti-Bacterial Agents↗