[Analysis of factors affecting soft tissue infection after oral and maxillofacial debridement]

PURPOSE

To explore the factors affecting soft tissue infection after oral and maxillofacial debridement.

METHODS

Fifty hundred patients with debridement were enrolled in this study from January 2013 to June 2016. The patients were divided into 2 groups according to soft tissue infection, 18 cases in infection group and 482 cases in non-infection group. Age, mean time to surgery, average length of stay, duration of antibiotics use, abbreviated injury scale (AIS), combined injuries, maxillofacial fractures, soft tissue injury, type of fracture, and history of diabetes were recorded and analyzed using SPSS 19.0 software package.

RESULTS

The factors influencing soft tissue infection after oral and maxillofacial surgery were the aged, longer hospital stay, longer operation time, longer antibiotics use time, higher AIS score, Jaw bone injury and diabetes.

CONCLUSIONS

The factors influencing soft tissue infection after oral and maxillofacial debridement are various. The aged, longer operation time, higher AIS score, jaw bone involvement lip and chin injury as well as diabetes might be the independent factors. Health care providers should give preventive measures to reduce the incidence of infection, according to specific factors.

Immunoglobulin for necrotising soft tissue infections (INSTINCT): protocol for a randomised trial

INTRODUCTION

Necrotising soft tissue infections (NSTI) are aggressive infections that can result in severe disability or death. Intravenous polyspecific immunoglobulin G (IVIG) is used as supplementary treatment for patients with NSTIs. The level of evidence is very low, but suggests that IVIG may have beneficial effects. However, IVIG may also have adverse effects. With this trial we will estimate the effects of IVIG on a patient-reported outcome and other patient-centred outcomes in patients with NSTI.

METHODS

INSTINCT is a randomised, double-blinded, parallel-group, placebo-controlled trial with concealed allocation of patients with NSTI 1:1 to IVIG or an equal volume of 0.9% saline. Patients are recruited at Rigshospitalet, Denmark. The primary outcome is the physical component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey as assessed six months after randomisation. Secondary outcomes are: mortality; time to resolution of shock; bleeding; sequential organ failure assessment scores on days 1-7; use of renal-replacement therapy, mechanical ventilation and vasopressors; days alive and out of hospital; amputation; and severe adverse reactions.

CONCLUSION

This study will be the only completed trial testing IVIG for NSTI, thereby providing important data on a severely sick patient group.

FUNDING

The trial is supported by CSL Behring in the form of trial medication and a € 92,182 grant for trial conduct, research, nurse salary and statistical analyses.

TRIAL REGISTRATION

The trial is registered with clinicaltrials.gov (NCT02111161). .

Airway management in patients with deep neck infections: A retrospective analysis

Securing the airway in patients undergoing surgical intervention to control a deep neck infection (DNI) is challenging for anesthesiologists due to the distorted airway anatomy, limited mouth opening, tissue edema, and immobility. It is critical to assess the risk of a potential difficult airway and prepare the most appropriate airway management method.We reviewed our anesthetic experiences managing patients with DNIs, focusing on the need for video-laryngoscope or awake fiberoptic intubation beyond a standard intubation from the anesthesiologist's perspective.When patients had infections in the masticatory space, mouth of floor, oropharyngeal mucosal space, or laryngopharynx, their airways tended to be managed using methods requiring more effort by the anesthesiologists, and more extensive equipment preparation, compared with use of a standard laryngoscope. The degree to which the main lesion influenced the airway anatomy, especially at the level of epiglottis and aryepiglottic fold was related to the airway management method selected.When managing the airways of patients undergoing surgery for DNIs under general anesthesia, anesthesiologists should use imaging with computed tomography to evaluate the preoperative airway status and a comprehensive understanding of radiological findings, comorbidities, and patients' symptoms is needed.

A Rhizopus oryzae strain isolated from resected bone and soft tissue specimens from a sinonasal and palatal mucormycosis case. Report of a case and in vitro experiments of yeastlike cell development

We report a histologically and mycologically proven sinonasal mucormycosis case causing palatal necrosis in a nondiabetic patient with renal failure. Mycological examination of Giemsa stained imprinted tissue preparations revealed abundant yeast-like cells besides the typical mucoraceous hyphae. The fungus was isolated from surgical specimens and identified as Rhizopus oryzae by phenotypic and genotypic tests. Laboratory studies were performed to investigate the association of the yeast-like cells observed in tissue specimens and the fungus recovered in culture. In vitro induced yeast-like cell development of the case isolate was found under certain growth conditions and documented by photomicrographs.

Clinical characteristics of group B streptococcus bacteremia in non-pregnant adults

BACKGROUND AND PURPOSE

Group B streptococcus (GBS) [Streptococcus agalactiae] is an emerging cause of disease in non-pregnant adults with underlying diseases. This retrospective study analyzed 90 episodes of GBS bacteremia in adults occurring over a 4-year period.

METHODS

Basic and clinical data were collected by reviewing medical charts of patients. Blood cultures were performed on admission of patients suspected of bacteremia. Presence of underlying diseases, such as liver disease, heart disease, urinary tract disorders, and female-specific cancers, as well as possible portals of entry of infection was analyzed.

RESULTS

In 56 episodes (62.2%), patients were aged 60 years or older and 40 (44.4%) episodes occurred in males. Skin and soft tissue were the most common sources of GBS bacteremia (22/90, 24.4%). GBS bacteremia was classified as primary in 50% of the episodes (45 patients). Liver diseases were more common in males, while malignancy was more common in females. Portals of entry with a significant gender predominance included skin and soft tissue in women (p=0.018), bone and joint in women (p=0.016), and urinary tract in men (p=0.042). The overall mortality rate was 18.9% and the attributable mortality rate was 7.8%.

CONCLUSIONS

Elderly people and those with underlying diseases are particularly susceptible to GBS infections. Preventive strategies, including GBS vaccine and skin care, are likely to be particularly important in these high-risk groups.

[Deep neck abscess: analysis of 50 cases]

OBJECTIVE

To identify the predisposing factors of deep neck abscess and review diagnosis and treatment experience.

METHODS

A respective review was conducted in 50 cases who were diagnosed as having deep neck abscess in this hospital from Jan. 1997 to Dec. 2002.

RESULTS

The causes of deep neck abscess were tooth diseases (3 cases), acute tonsillitis and laryngitis (8 cases), infection of upper respiratory tract (9 cases), foreign bodies in esophagus (14 cases), diabetes mellitus (5 cases), uncertain cause (11 cases). Among 21 cases of pus bacterial cultivation, 13 (64%) cases were positive. By different ways of drainage including neck-mediastinum incision, and use of large dosage of antibiotics, 46 six cases were cured and 4 cases died. Two died of massive hemorrhage of neck blood vessel burst, one massive hemorrhage of upper digestive tract, another infective shock.

CONCLUSIONS

Once deep neck abscess is diagnosed, early surgical drainage, appropriate use of antibiotics and control of complications and accompanying diseases are very important to improve the cure rate.

Vibrio vulnificus infection of the upper extremity

Vibrio vulnificus is a potentially limb- and life-threatening infection. This pathogen should be suspected in any patient with a rapidly progressive infection who has a history of saltwater contact. Although the infection may occur in otherwise healthy individuals, V vulnificus has a proclivity for patients with underlying chronic disease, particularly hepatic dysfunction. Prompt recognition and immediate treatment with antibiotics and possibly surgical débridement may prevent amputation or death.

Foot Problems in Diabetes: An Overview

Diabetes is the leading cause of nontraumatic lower-extremity amputations in the United States. Most amputations are preceded by an ulcer, and ulcers are costly in their own right. Most ulcers are neuropathic in etiology and plantar in location. They occur typically at sites of high mechanical loading because of repetitive trauma in people with loss of pain sensation. In an adequately perfused limb, such ulcers are not difficult to heal. When they are properly mechanically off-loaded, approximately 90% of these wounds heal in approximately 6 weeks. The reference standard off-loading device is the total contact cast, but other reasonably efficacious methods exist. Screening and implementation of preventive measures in the high-risk patient are highly recommended and can reduce the incidence of ulceration. All patients with diabetes should be screened annually for loss of protective sensation, with the 10-g Semmes-Weinstein monofilament being the easiest tool to use. Education to prevent complications should be implemented for all patients with loss of protective sensation.

Sepsis syndrome

A clinical syndrome including fever, leukocytosis, elevated cardiac output, and reduced systemic vascular resistance has been associated with severe infection (i.e., sepsis). However, during the last 15 years, many patients have demonstrated all of the findings that have traditionally been associated with "sepsis" but have not had demonstrated sources of infection. This led to the term "sepsis syndrome" to refer to that population of patients who appeared to have a physiologic and metabolic response associated with, but who did not have, severe infection. More commonly called the systemic inflammatory response syndrome (SIRS), the sepsis syndrome is now associated with the nonspecific systemic activation of the human inflammatory cascade by any of a number of clinical events. The management of the SIRS patient has been ineffective because of incomplete definition of the mechanisms responsible for the syndrome. It is argued that all of the biological mechanisms that are operative in a simple wound and are beneficial are negative for the host when activated systemically. Thus, SIRS is seen in three separate scenarios at present: (1) invasive infection; (2) dissemination of microbes secondary to failure of host defense mechanisms; and (3) severe activation of inflammation by injury, shock, severe soft tissue inflammation, and other noninfectious but proinflammatory events. Newer treatment strategies will need to focus not on the inciting event itself but on better control of the complex responses of the host.

Soft tissue infections

Soft tissue infections are almost routinely the product of direct microbe inoculation through a bridged protective skin. Day of onset and clinical presentation reflect the causative pathogen(s) and course that should be taken in treatment. Exclusive of chronic states, only in the most fulminating cases are culture and antimicrobial drugs of any real value.

Hand infections in the trauma patient

Infections are a frequent, unfortunate complication seen in orthopedic trauma patients. The specific anatomy of the upper extremity makes it an easy target for opportunistic organisms, especially after an acute traumatic event. In addition, pathogenic factors and host factors can contribute to the severity of the infection. Meticulous wound management, identification of the offending organism(s), and tailoring of care to the special needs of the very sick trauma patient limit complications.

Infection following treatment of mandibular fractures in human immunodeficiency virus seropositive patients

PURPOSE

There are little data available on the prevalence of human immunodeficiency virus (HIV) disease and its relationship to postoperative infection in patients presenting with mandibular fractures. This retrospective study assesses these parameters.

PATIENTS

The study population consisted of 251 patients treated for mandibular fractures at San Francisco General Hospital (SFGH) between January 1990 and December 1993. Group 1 (n = 20) was composed of patients with documented HIV infection and group 2 (n = 231) served as controls. The groups were comparable with regard to age, sex, etiology, and number and types of fractures.

RESULTS

HIV prevalence for this population was 7.9%, and was consistent with previously documented prevalence studies in SFGH surgical patients. In the HIV-positive group, 6 of 20 patients (30%) developed postoperative infection: 2 soft tissue (10%) and 4 bone-related (20%). In the control group, 22 of 231 patients (9.5%) developed postoperative infections: 16 soft tissue (6.9%) and 6 bone-related (2.6%). Statistical analysis showed a significant difference between the two groups with regard to overall (P = .016) and to bone-related (P = .001) infection rates. There was no statistically significant difference in soft tissue infections between the two groups (P = .953). The rate of postoperative infection was significantly higher in those patients (both HIV-positive and controls) who had open reduction and internal fixation (ORIF; 25/155; 16%) versus those who had closed reduction and maxillomandibular fixation (3/96; 3.1%; P = .003). The postoperative infection rate after ORIF was significantly higher in the HIV-positive (5/11; 45%) compared with the control group (20/144; 13.9%; P = .02).

CONCLUSIONS

The results of this study indicate that the overall rate of postoperative infection after treatment of mandibular fractures is significantly higher in HIV-positive than in HIV-negative patients. Specifically, the use of ORIF in HIV-positive patients represents a significant risk.