Effect of LY333328 against vancomycin-resistant Enterococcus faecium in a rat central venous catheter-associated infection model.
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A rat central venous catheter (CVC) infection model was used to assess the activity of LY333328 against vancomycin-resistant Enterococcus faecium (VRE). Via the CVC, animals were challenged with 10(6) cfu of Enterococcus faecium with the VanA phenotype. Eight rats received a single dose of LY333328 and eight rats received saline. Seventy-five per cent of control animals had peripheral bacteraemia and 87.5% had VRE recovered from explanted CVCs at the time they were killed, as compared with 0 and 12.5%, respectively, of the LY333328-treated animals (P < 0.01). All animals in the control group had evidence of metastatic disease compared with none of the treated group (P < 0.01). LY333328 was effective against the strain of VRE tested in this model. (+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)
A prospective audit of complex wound and graft infections in Great Britain and Ireland: the emergence of MRSA.
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BACKGROUND: a number of studies have examined the outcome of complex wound and graft infections, but most include small numbers of patients collected over a prolonged period of time. To date, there is little information on the clinical outcome of infections involving methicillin-resistant Staphylococcus aureus (MRSA). METHODS: between February 1998 and January 1999, two prospective multi-centre audits were performed in order to examine the current outcomes following (1) complex vascular wound infections and (2) graft infections in Britain and Ireland with particular reference to outcome associated with MRSA infection. RESULTS: seventy-five complex wound infections (Szylagyi II and III) were reported, with the commonest single organism being MRSA. Type II infections were associated with a 5% risk of death and/or amputation as opposed to 75% in those with a type III infection. Fifty-five graft infections were reported, with the commonest single organism being MRSA. Overall, 30 (55%) died or underwent amputation. MRSA wound and graft infections were associated with a significantly higher risk of amputation and prolonged hospital stay (but not of death) as compared with MRSA negative patients. CONCLUSIONS: in this audit, MRSA was the commonest single organism cultured in patients with complex wound and graft infections after vascular surgery. This represents a major change in the spectrum of causative organisms relative to other, older published series. MRSA infections contribute towards an increased risk of adverse outcome and prolonged hospital stay. (+info)
Primary total hip arthroplasty in patients with rheumatoid arthritis.
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Twenty-eight (11 cemented and 17 noncemented) total hip arthroplasties (THA) were performed in 20 patients with rheumatoid arthritis (RA). The average age at operation was 42.1 years and the average follow-up was 10.8 years. There were two deep infections requiring removal of the prosthesis. Three cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. One cemented cup was loosened radiologically. One PCA polyethylene liner was revised because of significant wear. Both cemented and noncemented femoral components are capable of providing respectable results in RA patients. The relatively inferior results of THA among RA patients is due not only to the fixation method, but also to the poorer bone quality. (+info)
Hydroxyapatite coated hip prosthesis followed up for 5 years.
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We prospectively studied 250 patients with a proximal hydroxyapatite coated hip prosthesis. The follow-up period was 5 years. All components showed osseointegration except for one deep infection. The morphology of bone remodeling with either endosteal bone formation or periosteal bone formation was dependent on the way the stem filled the medullary canal. No linear or distal osteolysis around the stems was observed. (+info)
Biomaterial-associated infection of gentamicin-loaded PMMA beads in orthopaedic revision surgery.
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In two-stage orthopaedic revision surgery, high local levels of antibiotics are achieved after removal of an infected prosthesis through temporary implantation of gentamicin-loaded beads. However, despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferentially adhere, grow and potentially develop antibiotic resistance. Gentamicin-loaded beads were retrieved from 20 patients with prosthesis-related infections. Excised tissue samples were taken for routine culture, while beads were analysed in an extensive laboratory procedure. Extensive culture procedures indicated the presence of bacteria on gentamicin-loaded beads in 18 of the 20 patients involved, while 12 of these 18 patients were considered free of infection by routine culture. Nineteen of 28 bacterial strains isolated were gentamicin resistant and cultures from three patients yielded highly gentamicin-resistant sub-populations. It is concluded that routine culture of excised tissues in orthopaedic revision surgery is inadequate to ascertain full eradication of infection, especially as infecting, antibiotic-resistant bacteria preferentially adhere to and grow on gentamicin-loaded beads. Extensive examination of the bead surfaces is proposed as a more reliable indication that infection has been eradicated. (+info)
Durability of anti-infective effect of long-term silicone sheath catheters impregnated with antimicrobial agents.
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This study was performed to test the long-term antimicrobial efficacy of impregnated silicone catheters comprising an antimicrobial layer sandwiched between an external surface sheath and a luminal surface silicone sheath. The design of the catheter permits the introduction of various antimicrobials in addition to anticoagulants or antifibrins in the antimicrobial layer and allows their gradual release over a period of months after insertion. The in vitro data presented show that the catheter can provide antimicrobial activity for 90 days, after being replated for 15 7-day cycles of replating. When the catheters were immersed in human serum and incubated at 37 degrees C, they demonstrated significant antimicrobial activity after more than 325 days of incubation. The significant long-term in vitro antimicrobial activity observed may imply effective in vivo activity for almost 1 year after insertion and could serve as a cost-effective alternative to surgically implantable silicone catheters. (+info)
Molecular identification of a Dietzia maris hip prosthesis infection isolate.
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Dietzia maris, an environmental actinomycete, has been implicated only once in human disease. We herein report the first D. maris isolate from a bone biopsy specimen in a patient hospitalized for a total hip prosthesis replacement. Cell wall fatty acid analysis and 16S ribosomal DNA gene sequencing were utilized to achieve its definite identification. This case report illustrates the usefulness of such methods for the accurate identification of actinomycetes. (+info)