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Durkin SR, Muecke JS. Successful treatment of a large choroidal abscess in an immunocompetent child. Treatment of a choroidal abscess. Graefes Arch Clin Exp Ophthalmol 2007; 245:1233-5. [PMID: 17219114 DOI: 10.1007/s00417-006-0509-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 10/26/2006] [Accepted: 11/20/2006] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We report the case of a systemically well 4-year-old Aboriginal boy who developed a choroidal abscess after being poked in the left eye with a blunt object. CASE REPORT This boy presented with redness and reduced vision in the left eye after a blunt object was poked into his eye by his sibling. He was noted to have a choroidal mass which finally manifested as a choroidal abscess. RESULTS His initial visual acuity was 6/60, and dilated fundus examination demonstrated a localised solid-appearing choroidal elevation involving the posterior pole, including the macula. An ultrasound of the eye revealed a choroidal haematoma with an atypical appearance, whose height was 8 mm with a base of 12 mm x 10 mm. The lesion failed to resolve, and eventually resulted in orbital cellulitis that did not respond to intravenous and topical antibiotic treatment. He then went on to achieve complete visual recovery after successful management by transcleral incision, drainage and systemic antibiotic therapy. CONCLUSION Choroidal abscess has been described in patients who are debilitated, immunocompromised or suffer with systemic disease such as cystic fibrosis or endocarditis. This case represents a unique report of staphylococcal choroidal abscess in a healthy child that completely resolved after transcleral drainage and systemic antibiotics.
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Gianella S, Ulrich S, Huttner B, Speich R. Conservative management of a brain abscess in a patient with Staphylococcus lugdunensis endocarditis. Eur J Clin Microbiol Infect Dis 2006; 25:476-8. [PMID: 16819618 DOI: 10.1007/s10096-006-0169-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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53
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Marwick C, Olver WJ. Treatment of Staphylococcus aureus bacteraemia. BMJ 2006; 333:397. [PMID: 16916836 PMCID: PMC1550474 DOI: 10.1136/bmj.333.7564.397-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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54
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Dunst KM, Huemer GM, Wayand W, Shamiyeh A. Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein. J Vasc Surg 2006; 43:1056-8. [PMID: 16678705 DOI: 10.1016/j.jvs.2006.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 01/31/2006] [Indexed: 10/24/2022]
Abstract
Endovenous laser treatment (EVLT) has become a valuable and safe option in the treatment of varicose veins. Although long-term results are lacking, most patients seem to benefit in the short-term from EVLT. Reported postoperative complications are limited, consisting usually of pain, ecchymosis, induration, phlebitis, or spot skin burn injuries. The most feared complication is an extension of the saphenous thrombus into the femoral vein, with possible pulmonary embolism. Here we report a septic thrombophlebitis after EVLT resulting in a phlegmonous infection of the whole leg that was treated by surgical drainage. Aggressive local therapy and antibiotic treatment resulted in complete resolution of symptoms and eventual satisfactory healing.
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Maegele M. Re: the role of antibiotic prophylaxis in clean incised hand injuries: a prospective randomized placebo controlled double blind trial, Whittaker JP, Nancarrow JD, Sterne GD, Journal of Hand Surgery, 2005, 30B: 162-167. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2006; 31:245; author reply 245-6. [PMID: 16343712 DOI: 10.1016/j.jhsb.2005.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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56
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Jukema GN, Steenvoorde P, Wong CY, Bernards AT, van Dissel JT. [Maggot therapy for treatment of severe infections in trauma surgery: "back to the future!"]. Zentralbl Chir 2006; 131 Suppl 1:S75-8. [PMID: 16575650 DOI: 10.1055/s-2006-921510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.
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Alajlan A, Al-Khawajah M, Al-Sheikh O, Al-Saif F, Al-Rasheed S, Al-Hoqail I, Hamadah IR. Treatment of linear IgA bullous dermatosis of childhood with flucloxacillin. J Am Acad Dermatol 2006; 54:652-6. [PMID: 16546588 DOI: 10.1016/j.jaad.2005.11.1102] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 11/29/2005] [Accepted: 11/30/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Linear IgA bullous dermatosis of childhood is a rare autoimmune bullous disease that mainly affects preschool-aged children. Dapsone is considered the first-line therapy with prompt response from most patients. However, it may be contraindicated in certain conditions such as glucose-6-phosphate dehydrogenase deficiency. OBJECTIVE We sought to assess the efficacy of flucloxacillin in the treatment of linear IgA bullous dermatosis. METHODS This is an observational study in which all confirmed cases of linear IgA bullous dermatosis (by both histological and immunofluorescence studies) will be treated with flucloxacillin. Flucloxacillin will be continued according to the response or otherwise will be discontinued after 8 weeks in the case of resistance. RESULTS We describe 7 patients with linear IgA bullous dermatosis of childhood treated with flucloxacillin. In 4 cases, it induced complete remission within 3 to 4 months of starting therapy with no relapses. In the other 3 cases, it successfully controlled the disease but with prompt relapse on discontinuation of the treatment. LIMITATIONS This is a case series study with a small number of patients. CONCLUSION Flucloxacillin may be considered among the first alternative therapies for linear IgA bullous dermatosis of childhood. Further evaluation of the efficacy and safety of the long-term use is required.
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58
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Stricker T, Navratil F, Forster I, Hürlimann R, Sennhauser FH. Nonpuerperal mastitis in adolescents. J Pediatr 2006; 148:278-81. [PMID: 16492444 DOI: 10.1016/j.jpeds.2005.08.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 07/27/2005] [Accepted: 08/26/2005] [Indexed: 11/16/2022]
Abstract
Mastitis in non-lactating adolescents is rare and its cause unclear. This retrospective study summarizes 22 such episodes, in 3 of which Staphylococcus aureus was isolated. Serum prolactin levels were normal. Most patients were successfully treated with oral amoxicillin-clavulanic acid. Three patients with bilateral breast cysts had a recurrence.
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59
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Lo SJ, Hughes J, Armstrong A. Non-infective subcutaneous emphysema of the hand secondary to a minor webspace injury. ACTA ACUST UNITED AC 2005; 30:482-3. [PMID: 15993993 DOI: 10.1016/j.jhsb.2005.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 04/25/2005] [Indexed: 11/19/2022]
Abstract
Subcutaneous emphysema in the hand is commonly associated with infection or high-pressure injection injuries, with other non-infectious causes being reported as rarities in the literature. We describe an unusual case of minor injury to the first webspace resulting in significant subcutaneous emphysema.
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Rashid A, Brown AP, Khan K. On the use of prophylactic antibiotics in prevention of toxic shock syndrome. Burns 2005; 31:981-5. [PMID: 16288963 DOI: 10.1016/j.burns.2005.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 06/26/2005] [Indexed: 11/26/2022]
Abstract
No consensus exists among burn surgeons on the role of prophylactic antibiotics in prevention of toxic shock syndrome (TSS). We recently reported a series of 71 children admitted with burns to our burn unit. By Centres for Disease Control (CDC) criteria, six of these were 'definite' and four 'probable' cases of TSS. Prior to this report, none of our patients were given prophylactic antibiotics. Thereafter, prophylactic therapy was included in the management of children admitted to the burns unit. The aim of this study was to assess whether prophylaxis with a one off single dose of systemic antibiotics prevented the occurrence of TSS. Data were collected prospectively between 1 January and 31 December 2001, on all children admitted to the burns unit. Out of 50 children admitted to the burns unit, 39 received prophylactic antibiotics in the referring accident and emergency. Two of these became unwell but none fulfilled the CDC criteria. The remaining 11 patients were given antibiotics on admission out of which one child required direct admission to the intensive care unit with a working diagnosis of TSS. Retrospectively, his features did not conform to the CDC criteria. In conclusion, this study suggests that prophylaxis may prevent TSS in children.
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Iyer S, Lobo M, Capell W. Obturator internus pyomyositis: a differential diagnosis for septic arthritis of the hip. J Paediatr Child Health 2005; 41:534-5. [PMID: 16150077 DOI: 10.1111/j.1440-1754.2005.00700_2.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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62
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Pietroni M. Flucloxacillin associated neutropenia in children treated for bone and joint infections (J. Paediatr. Child Health 2005; 41: 48-51). J Paediatr Child Health 2005; 41:534. [PMID: 16150078 DOI: 10.1111/j.1440-1754.2005.00700_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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63
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Dobson JL, Angus PW, Jones R, Crowley P, Gow PJ. Flucloxacillin-induced aplastic anaemia and liver failure. Transpl Int 2005; 18:487-9. [PMID: 15773973 DOI: 10.1111/j.1432-2277.2004.00014.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Flucloxacillin is a commonly prescribed semisynthetic penicillinase-resistant penicillin primarily used for the treatment of cutaneous staphylococcal infections. It is well-recognized that flucloxacillin may occasionally result in fatal hepatic injury. We report the case of a 40-year-old woman who developed fulminant hepatic failure and aplastic anaemia following a course of oral flucloxacillin. At the time of transplantation the patient was severely neutropenic. Post-transplant, the patient received single donor leucocyte transfusions, which resulted in a dramatic increase in neutrophil count. The patient was discharged from hospital after 120 days with normal liver function and recovered bone marrow. In this report, we discuss the care of patients with aplastic anaemia in the peritransplant setting.
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Ali ZA, Lim E, Motalleb-Zadeh R, Ali AA, Callaghan CJ, Gerrard C, Vuylsteke A, Foweraker J, Tsui S. Allogenic blood transfusion does not predispose to infection after cardiac surgery. Ann Thorac Surg 2005; 78:1542-6. [PMID: 15511427 DOI: 10.1016/j.athoracsur.2004.05.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many retrospective studies report increased postoperative infection after allogenic blood transfusion. To investigate this phenomenon, we prospectively studied 232 patients undergoing cardiac surgery. METHODS Patients were screened daily for evidence of culture positive infections. Wounds were examined daily and defined on the ASEPSIS score. Chest radiographs and white cell counts and differentials were recorded on days 1, 2, and 4. The use of blood products was monitored blindly and independently. Patients were grouped according to transfusion status and compared using chi2 or Fisher's test. Logistic regression analyses were performed to identify predictors of transfusion and infection. RESULTS Of 232 patients, 116 (50%) received blood product transfusion. Patients receiving blood had lower preoperative hemoglobin, were older, with a greater proportion of urgent/emergency or revision surgery, and were higher risk. Despite this, there were no differences in the frequency of chest infection (20% versus 15%, p = 0.38), urinary infection (3.5% versus 5.3%, p = 0 0.75), wound infection (3.5% versus 8.0%, p = 0.16), or overall infection (28% versus 30%, p = 0.89) comparing the transfused versus untransfused groups. There was no evidence to suggest that administration of blood products was associated with infection (odds ratio 0.92, p = 0.77). CONCLUSIONS The administration of blood per se did not lead to increased postoperative infection. Clinicians should reconsider withholding blood transfusion in patients solely owing to concerns of predisposition to infection.
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Schrenzel J, Harbarth S, Schockmel G, Genné D, Bregenzer T, Flueckiger U, Petignat C, Jacobs F, Francioli P, Zimmerli W, Lew DP. A Randomized Clinical Trial to Compare Fleroxacin-Rifampicin with Flucloxacillin or Vancomycin for the Treatment of Staphylococcal Infection. Clin Infect Dis 2004; 39:1285-92. [PMID: 15494904 DOI: 10.1086/424506] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Accepted: 06/02/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Oral combination therapy with fluoroquinolones plus rifampicin is a promising alternative to standard parenteral therapy for staphylococcal infections. METHODS In a multicenter, randomized trial, we compared the efficacy, safety, and length of hospital stay for patients with staphylococcal infections treated either with an oral combination of a fluoroquinolone (fleroxacin) plus rifampicin or with standard parenteral treatment (flucloxacillin or vancomycin). Patients were included if cultures showed the presence of bacteremia or deep-seated infections with Staphylococcus aureus (104 patients) or catheter-related bacteremia due to drug-susceptible, coagulase-negative staphylococci (23 patients). RESULTS The cure rate in the intention-to-treat analysis was 78% for the fleroxacin-rifampicin group (68 patients) and 75% for the standard therapy group (59 patients; 47 received flucloxacillin, and 12 received vancomycin); in the population of clinically evaluable patients (n=119), the cure rate was 82% and 80%, respectively; and in the population of microbiologically evaluable patients (n=103), the cure rate was 86% and 84%, respectively. Clinical and bacteriological failures after S. aureus infections were documented in similar proportions of patients. The median length of hospital stay after study entry was 12 days in the fleroxacin-rifampicin group, compared with 23 days in the standard treatment group (P=.006). More adverse events probably related to the study drug were reported in the fleroxacin-rifampicin group than in the standard therapy group (15 of 68 vs. 5 of 59 patients; P=.05). CONCLUSIONS This study suggests that an oral regimen containing a fluoroquinolone plus rifampicin may be effective for treating staphylococcal infections, allowing earlier discharge from the hospital.
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Englert C, Aebert H, Lenhart M, Solleder A, Nerlich M, Neumann C. Thoracic spondylitis from a mycotic (Streptococcus pneumoniae) aortic aneurysm: a case report. Spine (Phila Pa 1976) 2004; 29:E373-5. [PMID: 15534400 DOI: 10.1097/01.brs.0000137061.79898.8f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described. SUMMARY OF BACKGROUND DATA Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies. METHODS The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 x 0.5 g/day, Cefotaxim 3 x 2 g/day, and Flucloxacillin 3 x 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter. RESULTS The patient made a good recovery and is free of recurrence 4 years after surgery. CONCLUSIONS Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.
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MESH Headings
- Aneurysm, Infected/complications
- Aneurysm, Infected/drug therapy
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Anti-Bacterial Agents/therapeutic use
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/drug therapy
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Blood Vessel Prosthesis Implantation
- Cefotaxime/therapeutic use
- Combined Modality Therapy
- Discitis/complications
- Discitis/drug therapy
- Discitis/surgery
- Fistula/diagnostic imaging
- Fistula/etiology
- Fistula/surgery
- Floxacillin/therapeutic use
- Humans
- Ischemia/etiology
- Lung Diseases/diagnostic imaging
- Lung Diseases/etiology
- Lung Diseases/surgery
- Male
- Metronidazole/therapeutic use
- Middle Aged
- Nervous System Diseases/etiology
- Osteomyelitis/drug therapy
- Osteomyelitis/etiology
- Osteomyelitis/microbiology
- Osteomyelitis/surgery
- Pneumococcal Infections/complications
- Pneumococcal Infections/drug therapy
- Pneumococcal Infections/surgery
- Pneumonia, Pneumococcal/complications
- Pneumonia, Pneumococcal/drug therapy
- Postoperative Complications/etiology
- Respiratory Tract Fistula/diagnostic imaging
- Respiratory Tract Fistula/etiology
- Respiratory Tract Fistula/surgery
- Spinal Cord/blood supply
- Spinal Diseases/diagnostic imaging
- Spinal Diseases/etiology
- Spinal Diseases/surgery
- Spondylitis/complications
- Spondylitis/drug therapy
- Spondylitis/surgery
- Streptococcus pneumoniae/isolation & purification
- Thoracic Vertebrae/microbiology
- Thoracic Vertebrae/surgery
- Tomography, X-Ray Computed
- Tracheal Diseases/diagnostic imaging
- Tracheal Diseases/etiology
- Treatment Outcome
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Smit M, Haasnoot K. [Diagnostic image (202). A newborn with subfebrile temperature and skin lesions. Staphylococcal scalded skin syndrome]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2004; 148:1631. [PMID: 15455510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A 6-day-old boy suffered from subfebrile temperature and progressive skin lesions with epidermolysis, due to Staphylococcus aureus: staphylococcal scalded skin syndrome.
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Ali F, Fernandes JA. Osteomyelitis of the accessory navicular bone in the foot. A case report. Acta Orthop Belg 2004; 70:287-9. [PMID: 15287412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The accessory navicular is one of the most symptomatic bones of the foot. Osteonecrosis and fracture of this bone have been previously described. We report a case of osteomyelitis of an accessory navicular bone in a young girl, to make treating clinicians aware of this rare possibility.
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van Damme PA. [Diagnostic image (185). A man with a pimple on the upper lip. Carbuncle of the upper lip]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2004; 148:777. [PMID: 15129566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 24-year-old man presented with a carbuncle of the upper lip. Surgical drainage was installed and flucloxacillin was administered. Full recovery ensued. In culture Staphylococcus aureus was abundant.
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Entenza JM, Vouillamoz J, Glauser MP, Moreillon P. Efficacy of garenoxacin in treatment of experimental endocarditis due to Staphylococcus aureus or viridans group streptococci. Antimicrob Agents Chemother 2004; 48:86-92. [PMID: 14693523 PMCID: PMC310157 DOI: 10.1128/aac.48.1.86-92.2004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The activity of garenoxacin was investigated in rats with experimental endocarditis due to staphylococci and viridans group streptococci (VGS). The staphylococci tested comprised one ciprofloxacin-susceptible and methicillin-susceptible Staphylococcus aureus (MSSA) isolate (isolate 1112), one ciprofloxacin-susceptible but methicillin-resistant S. aureus (MRSA) isolate (isolate P8), and one ciprofloxacin-resistant mutant (grlA) of P8 (isolate P8-4). The VGS tested comprised one penicillin-susceptible isolate and one penicillin-resistant isolate (Streptococcus oralis 226 and Streptococcus mitis 531, respectively). To simulate the kinetics of drugs in humans, rats were infused intravenously with garenoxacin every 24 h (peak and trough levels in serum, 6.1 and 1.0 mg/liter, respectively; area under the concentration-time curve [AUC], 63.4 mg. h/liter) or levofloxacin every 12 h (peak and trough levels in serum, 7.3 and 1.5 mg/liter, respectively; AUC, 55.6 mg. h/liter) for 3 or 5 days. Flucloxacillin, vancomycin, and ceftriaxone were used as control drugs. Garenoxacin, levofloxacin, flucloxacillin, and vancomycin sterilized >/=70% of the vegetations infected with both ciprofloxacin-susceptible staphylococcal isolates (P < 0.05 versus the results for the controls). Garenoxacin and vancomycin also sterilized 70% of the vegetations infected with ciprofloxacin-resistant MRSA isolate P8-4, whereas treatment with levofloxacin failed against this organism (cure rate, 0%; P < 0.05 versus the results obtained with the comparator drugs). Garenoxacin did not select for resistant derivatives in vivo. In contrast, levofloxacin selected for resistant variants in four of six rats infected with MRSA isolate P8-4. Garenoxacin sterilized 90% of the vegetations infected with both penicillin-susceptible and penicillin-resistant isolates of VGS. Levofloxacin sterilized only 22 and 40% of the vegetations infected with penicillin-susceptible S. oralis 226 and penicillin-resistant S. mitis 531, respectively. Ceftriaxone sterilized only 40% of those infected with penicillin-resistant S. mitis 531 (P < 0.05 versus the results obtained with garenoxacin). No quinolone-resistant VGS were detected. In all the experiments successful quinolone treatment was predicted by specific pharmacodynamic criteria (D. R. Andes and W. A. Craig, Clin. Infect. Dis. 27:47-50, 1998). The fact that the activity of garenoxacin was equal or superior to those of the standard comparators against staphylococci and VGS indicates that it is a potential alternative for the treatment of infections caused by such bacteria.
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Meyer B, Ahmed el Gendy S, Delle Karth G, Locker GJ, Heinz G, Jaeger W, Thalhammer F. How to calculate clearance of highly protein-bound drugs during continuous venovenous hemofiltration demonstrated with flucloxacillin. Kidney Blood Press Res 2004; 26:135-40. [PMID: 12771540 DOI: 10.1159/000070997] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Flucloxacillin is an important antimicrobial drug in the treatment of infections with Staphylococcus aureus and therefore is often used in staphylococcal infections. Furthermore, flucloxacillin has a high protein binding rate as for example ceftriaxone or teicoplanin--drugs which have formerly been characterized as not being dialyzable. METHODS The pharmacokinetic parameters of 4.0 g flucloxacillin every 8 h were examined in 10 intensive care patients during continuous venovenous hemofiltration (CVVH) using a polyamide capillary hemofilter. In addition, the difficulty of calculating the hemofiltration clearance of a highly protein-bound drug is described. RESULTS Flucloxacillin serum levels were significantly lowered (56.9 +/- 24.0%) even though only 15% of the drug was detected in the ultrafiltrate. Elimination half-life, total body clearance and sieving coefficient were 4.9 +/- 0.7 h, 117.2 +/- 79.1 ml/min and 0.21 +/- 0.09, respectively. These discrepancies can be explained by the high protein binding of flucloxacillin, the adsorbing property of polyamide and the equation in order to calculate hemofiltration clearance. The unbound fraction of a 4.0 g flucloxacillin dosage facilitates time above the minimum inhibitory concentration (T > MIC) of 60% only for strains up to a minimum inhibitory concentration (MIC) of 0.5 mg/l. CONCLUSION Based on the data of this study, we conclude that intensive care patients with staphylococcal infections on CVVH should be treated with 4.0 g flucloxacillin every 8 h which was safe and well tolerated. Moreover, further studies with highly protein-bound drugs are recommended to check the classical 'hemodialysis' equation as the standard equation in calculating the CVVH clearance of highly protein-bound drugs.
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May MLA. Congenital cyanotic heart disease and headache. J Paediatr Child Health 2004; 40:60-2. [PMID: 14718008 DOI: 10.1111/j.1440-1754.2004.00293.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Stevenson J, McNaughton G, Riley J. The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2003; 28:388-94. [PMID: 12954243 DOI: 10.1016/s0266-7681(03)00175-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.
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