Successful administration of quinupristin/dalfopristin in the outpatient setting.
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Intravenous administration of quinupristin/dalfopristin outside the hospital setting has not been reported previously. We describe 37 outpatients receiving quinupristin/dalfopristin iv for infections including osteomyelitis, bacteraemia, abscesses and cellulitis. The most frequent aetiological pathogens found were Enterococcus faecium, Staphylococcus aureus and coagulase-negative staphylococci. Patients received an average of 9 days therapy as inpatients and 22 days as outpatients. Quinupristin/dalfopristin was administered using various access devices, most commonly peripherally inserted central catheters and tunnelled central catheters. The bacteriological and clinical success rates were both 89.2%. Five patients were readmitted to hospital; one patient developed catheter-related bacteraemia. The most frequently reported non-venous adverse events were nausea (18.9% of patients), myalgia (18.9%) and arthralgia (13.5%). Sixteen patients experienced venous access-related events, most commonly infusion pain, oedema and phlebitis. In this group of patients, for those who had difficult-to-treat infections, intravenous quinupristin/dalfopristin therapy was generally effective and safe outside the hospital setting. (+info)
Usefulness of 99mTc-ciprofloxacin (infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy.
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99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections. METHODS: Fifty-six sites with suspected bone or joint infection were examined with 99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370-400 MBq infecton or 185-200 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies. RESULTS: There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With 99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients. CONCLUSION: Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy. (+info)
Iliac osteomyelitis and gluteal muscle abscess caused by Streptococcus intermedius.
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Streptococcus intermedius, included in the 'milleri group', is a commensal of the mouth and upper respiratory tract but it has often been associated with various pyogenic infections, such as endocarditis, pneumonia, abdominal or cerebral abscess, rarely with osteomyelitis, and exceptionally with muscular abscess. The first observed case of iliac osteomyelitis with gluteal muscle abscess caused by S. intermedius is reported. It is essential to recognise members of the 'milleri group' as possible agents of bone and muscle pyogenic infection because its management requires a timely diagnosis and prolonged antimicrobial treatment to achieve complete clinical and radiological recovery. (+info)
Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival.
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We studied prospectively a consecutive series of 50 patients with chronic osteomyelitis. Patients were allocated to the following treatment groups: 1) wide resection, with a clearance margin of 5 mm or more; 2) marginal resection, with a clearance margin of less than 5 mm; and 3) intralesional biopsy, with debulking of the infected area. All patients had a course of antibiotics, intravenously for six weeks followed by orally for a further six weeks. No patients in group 1 had recurrence. In patients treated by marginal resection (group 2), 8 of 29 (28%) had recurrence. All patients who had debulking had a recurrence within one year of surgery. We performed a survival analysis to determine the time of the recurrence of infection. In group 2 there was a higher rate of recurrence in type-B hosts (p < 0.05); no type-A hosts had recurrence. This information is of use in planning surgery for chronic osteomyelitis. (+info)
Percutaneous treatment of chronic MRSA osteomyelitis with a novel plant-derived antiseptic.
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BACKGROUND: Antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE, are an increasing problem world-wide, causing intractable wound infections. Complex phytochemical extracts such as tea tree oil and eucalypt-derived formulations have been shown to have strong bactericidal activity against MRSA in vitro. Polytoxinol (PT) antimicrobial, is the trade name of a range of antimicrobial preparations in solution, ointment and cream form. METHODS: We report the first use of this drug, administered percutaneously, via calcium sulphate pellets (Osteoset,TM), into bone, to treat an intractable MRSA infection of the lower tibia in an adult male. RESULTS AND DISCUSSION: Over a three month period his symptoms resolved with a healing response on x-ray and with a reduced CRP. (+info)
Chronic osteomyelitis: a continuing orthopaedic challenge in developing countries.
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Nine patients with chronic osteomyelitis, three with problems due to diagnosis, three with dilemmas regarding treatment and three with other complications are presented. It is suggested that although the diagnosis of osteomyelitis in most cases is straightforward, presentation might sometimes be similar to other conditions, which can lead to a dilemma in the diagnosis. Because of the formidable complications, which may be difficult to manage and the difficulty in guaranteeing permanent cure, the best approach is prevention by judicious treatment of acute haematogenous osteomyelitis and of open fractures. (+info)
Diagnosis and management of osteomyelitis.
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Acute osteomyelitis is the clinical term for a new infection in bone. This infection occurs predominantly in children and is often seeded hematogenously. In adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue. The specific organism isolated in bacterial osteomyelitis is often associated with the age of the patient or a common clinical scenario (i.e., trauma or recent surgery). Staphylococcus aureus is implicated in most patients with acute hematogenous osteomyelitis. Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, Serratia marcescens and Escherichia coli are commonly isolated in patients with chronic osteomyelitis. For optimal results, antibiotic therapy must be started early, with antimicrobial agents administered parenterally for at least four to six weeks. Treatment generally involves evaluation, staging, determination of microbial etiology and susceptibilities, antimicrobial therapy and, if necessary, debridement, dead-space management and stabilization of bone. (+info)
Two-staged operation for thoracolumbar osteomyelitis following methicillin-resistant staphylococcus aureus infection of a craniectomy wound--case report.
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A previously healthy 53-year-old woman developed pyogenic vertebral osteomyelitis (PVO) manifesting as progressive lumbago following wound infection of a decompressive craniectomy performed for brain contusion caused by a traffic accident. Magnetic resonance imaging disclosed vertebral osteomyelitis at T-12 and L-1 with paravertebral abscess. Anterior debridement and fusion using autografts were performed at the first operation. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the abscess specimen. Antibiotic therapy resolved the infection. Pedicle screw fixation was performed at the second operation. The patient became free from back pain and no recurrence of infection was seen. The diagnosis of PVO is frequently observed or delayed because of the nonspecific symptomatic presentation in the early stage. Coexistent infection or trauma makes early diagnosis more difficult. Indications and timing of instrumentation for the spinal column infected with MRSA is difficult. Two-staged operation with anterior debridement and posterior instrumentation after eradication of the infection is a safe and effective procedure for MRSA vertebral osteomyelitis. (+info)