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Brook I. Overview of anaerobic infections in children and their treatment. J Infect Chemother 2024; 30:1104-1113. [PMID: 39029623 DOI: 10.1016/j.jiac.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/30/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
Anaerobic bacteria can cause many infections in children. Because they predominant in the normal human skin and mucous membranes bacterial flora, they are often associated with bacterial infections that originate from these sites. They are difficult to isolate from infectious sites, and are frequently missed. Anaerobic infections can occur in all body sites, including the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Anaerobes colonize the newborn after birth and have been isolated in several types of neonatal infections. These include cellulitis of the site of fetal monitoring, neonatal aspiration pneumonia, bacteremia, conjunctivitis, omphalitis, and infant botulism. Management of anaerobic infection is challenging because of the slow growth of these bacteria, by their polymicrobial nature and by the growing antimicrobial resistance of anaerobic. Antimicrobial therapy may be the only treatment required, and may also be an adjunct to a surgical approach. Polymicrobial aerobic-anaerobic infection generally requires delivering antimicrobial therapy effective against all pathogens. The antibiotics with the greatest activity against anaerobes include carbapenems, beta-lactam/beta-lactamase inhibitor combinations, metronidazole, and chloramphenicol. Antimicrobial resistance is growing among anaerobic bacteria. The major increased in resistance have been reported with clindamycin, cephamycins, and moxifloxacin against Bacteroides fragilis group and related strains. Resistance patterns vary between different geographic areas and medical facilities.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, Washington DC, USA.
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2
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Zabihi F, Bastami SJ, Atqiaee K. A rare case of necrotizing fasciitis after early infant male circumcision. Clin Case Rep 2022; 10:e6409. [PMID: 36245473 PMCID: PMC9551189 DOI: 10.1002/ccr3.6409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/07/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Even though circumcision is low-risk, complications may occur, necessitating careful management. Here, we describe a 5-month-and-28-day-old infant who developed necrotizing fasciitis following Plastibell circumcision. This report emphasizes that clinicians should use standard equipment and appropriate-sized rings to prevent these unusual complications following circumcision.
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Affiliation(s)
- Fariba Zabihi
- Resident of General Surgery, Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Saeid Jamalie Bastami
- Resident of Anesthesiology, Anesthesiology DepartmentMashhad University of Medical SciencesMashhadIran
| | - Khashayar Atqiaee
- Department of Pediatric Surgery, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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3
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Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision? Int J Impot Res 2022; 35:256-263. [PMID: 34997197 DOI: 10.1038/s41443-021-00502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023]
Abstract
Non-therapeutic circumcision refers to the surgical removal of part or all of the foreskin, in healthy males, where there is no medical condition requiring surgery. The arguments for and against this practice in children have been debated for many years, with conflicting and conflicted evidence presented on both sides. Here, we explore the evidence behind the claimed benefits and risks from a medical and health-related perspective. We examine the number of circumcisions which would be required to achieve each purported benefit, and set that against the reported rates of short- and long-term complications. We conclude that non-therapeutic circumcision performed on otherwise healthy infants or children has little or no high-quality medical evidence to support its overall benefit. Moreover, it is associated with rare but avoidable harm and even occasional deaths. From the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold informed consent himself. We feel that the evidence presented in this review is essential information for all parents and practitioners considering non-therapeutic circumcisions on otherwise healthy infants and children.
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Affiliation(s)
| | - Gordon Muir
- Urology Department, King's College Hospital, London, UK.
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Iacob SI, Feinn RS, Sardi L. Systematic review of complications arising from male circumcision. BJUI COMPASS 2021; 3:99-123. [PMID: 35474726 PMCID: PMC8988744 DOI: 10.1002/bco2.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background Neonatal male circumcision is the most common procedure performed on paediatric patients (Simpson et al., 2014) and one of the most common surgical procedures in the world (American Academy of Pediatrics, 2012). Methods A search was conducted for articles about complications arising from male circumcision surgeries by entering the term ‘male circumcision’ into PubMed on June 16, 2020. Six thousand six hundred forty‐one articles published from 1945 to 2020 were found. Seventy‐eight articles were ultimately selected for the systematic review. Results The 78 articles selected from the literature search were entered into one of three tables. The first table includes 15 articles pertaining to chart reviews and cohort studies and report complication rates. The second table reports specific complications from 51 case reports and case series, and the third table is a summary from 12 articles regarding physician questionnaires and society recommendations. Additionally, the 78 articles were used to compile a list of 47 specific complications arising from male circumcision surgeries. Conclusions Complications from neonatal male circumcisions are common and healthcare providers need to be better informed of the potential complications of the surgery so that they can more effectively counsel their patients about potential risks, likelihood of complications and what can be done to prevent them. While experienced providers who practice in sterile settings have better outcomes with fewer complications, encouraging parents to take into account who is performing their son's circumcision, what was their training, how clean is their practice and how much experience they have and reminding them they have the option to decline the procedure entirely allow the parents to get a more complete picture and play an essential role in the decision‐making process.
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Affiliation(s)
- Stanca Iris Iacob
- Frank H. Netter MD School of Medicine Quinnipiac University North Haven Connecticut USA
| | - Richard S. Feinn
- Frank H. Netter MD School of Medicine Quinnipiac University North Haven Connecticut USA
| | - Lauren Sardi
- Department of Sociology Quinnipiac University Hamden Connecticut USA
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Patel T, Quow K, Cardones AR. Management of Infectious Emergencies for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2021; 10:232-242. [PMID: 34642610 PMCID: PMC8493951 DOI: 10.1007/s13671-021-00334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review There are various dermatologic emergencies stemming from bacterial, viral, and fungal etiologies that can present in the inpatient setting. This review summarizes the pathogenesis and diagnosis of infections with cutaneous involvement and highlights new therapies. Recent Findings Clindamycin inhibits toxin formation and can be used as an adjunct therapy for the staphylococcal scalded syndrome. Isavuconazole therapy for mucormycosis infection is a less toxic alternative to amphotericin B. Summary Diagnosis of these infections is primarily guided by high clinical suspicion and early recognition can prevent dangerous sequelae. Treatment mainstays have been well-established, but there are adjunctive therapies that may potentially benefit the patient.
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Affiliation(s)
- Tulsi Patel
- Duke University School of Medicine, Durham, NC 27710 USA
| | - Krystina Quow
- Department of Dermatology, Duke University, Durham, NC 27710 USA
| | - Adela R Cardones
- Department of Dermatology, Duke University, Durham, NC 27710 USA
- Durham VA Medical Center, Durham, NC 27705 USA
- Durham, USA
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Khalil A, Hamid E, Siddiq K, Hassan M. Methicillin-resistant Staphylococcus aureus urosepsis: A rare complication of neonatal circumcision. SAGE Open Med Case Rep 2020; 8:2050313X20966122. [PMID: 33194202 PMCID: PMC7594234 DOI: 10.1177/2050313x20966122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
The role of circumcision and its benefits has received increased attention across
several disciplines in recent years; however, there is increasing concern that
some uncommon complications such as severe infections are being related to
post-circumcision. We describe the clinical course of a 14-day-old boy who had
Methicillin-resistant Staphylococcus aureus urosepsis after
circumcision.
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Affiliation(s)
- Ahmed Khalil
- Department of Pharmacy, Hamad General Hospital, Doha, Qatar
| | - Eiman Hamid
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Siddiq
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Manasik Hassan
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
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Jiang ZL, Sun CW, Sun J, Shi GF, Li H. Subcutaneous tissue-sparing dorsal slit with new marking technique: A novel circumcision method. Medicine (Baltimore) 2019; 98:e15322. [PMID: 31008987 PMCID: PMC6494260 DOI: 10.1097/md.0000000000015322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Circumcision is a very common surgical procedure that is performed for medical and traditional purposes in the world. However, many technical of circumcision is needed to improve. Thus, this study introduced a novel method of circumcision that is a refined version of the sleeve technique, termed subcutaneous tissue sparing dorsal slit with new marking, and evaluated the safety and efficacy of this novel method of circumcision.The randomized clinical trial included 93 adult patients with redundant foreskin or phimosis treated from May 2015 to March 2017. Patients were randomly divided into the novel circumcision method (n = 45) or conventional dissection (n = 48). The groups were compared regarding rates of intraoperative hemorrhage, operative time, pain, healing, satisfaction with penis appearance, and relevant adverse events.No patient suffered any obvious complication. Compared with the patients given conventional dissection, the patients who underwent the new surgical device experienced significantly less wound healing time, scar width, and recovery time (P <.05). The new method resulted in greater intraoperative bleeding volume and surgical time (P <.05). The rate of satisfaction with appearance of the penis was significantly higher in the group treated with the novel technique. In addition, the cost of surgery of these 2 methods was similar.Based on the above research, we found that subcutaneous tissue-sparing dorsal slit with new marking technique was an effective and safe procedure for circumcision, and deserved further application in clinical practice.
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Affiliation(s)
| | - Cheng-Wen Sun
- Department of Urology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jian Sun
- Department of Urology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | | | - Hu Li
- Department of Plastic Surgery
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Kim JK, Koyle MA, Chua ME, Ming JM, Lee MJ, Kesavan A, Saunders M, Dos Santos J. Assessment of risk factors for surgical complications in neonatal circumcision clinic. Can Urol Assoc J 2018; 13:E108-E112. [PMID: 30273119 DOI: 10.5489/cuaj.5460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Despite the widespread use of circumcision, there is little understanding regarding risk factors associated with its complications. This investigation assesses potential risk factors contributing to complications of circumcision. METHODS A retrospective review of all males who underwent a neonatal circumcision in our institution's pediatric urology clinic between January 2015 and June 2017 was performed. Continuous variables were dichotomized to determine a clinically relevant cutoff value. Multivariate regression analyses were used to identify risk factors for primary outcomes (early/late complications) and secondary outcomes (emergency room [ER] visitation, return to operating room, post-circumcision communications). RESULTS A total of 277 patients were identified. The mean age and weight were 28.4 days and 4.3 kg, respectively; 93.1% of cases were elective and 12.3% of patients had comorbidities. Circumcisions were performed using Mogen (61.4%) or Gomco clamps (39.6%) under local anesthesia. Overall, 35 patients experienced complications (12.6%). There were 18 patients (6.5%) with bleeding requiring sutures at time of circumcision. Twenty-six patients (9.4%) experienced long-term complications, with penile adhesions being the majority (84.6%). One (0.4%) of these patients had a Clavien-Dindo 3 complication requiring surgery for a skin bridge that could not be separated. One patient (0.4%) visited the ER due to postoperative bleeding from the circumcised area, which was managed conservatively. Multivariate regression analysis identified weight >5.1 kg as a risk factor for bleeding requiring sutures (odds ratio [OR] 4.145; 95% confidence interval [CI] 1.246-13.799) and long-term complications (OR 3.738; 95% CI 1.356-10.306). No risk factors were identified for other outcomes (return to operating room, ER visitation, post-circumcision email/telephone communications). CONCLUSIONS This investigation of neonatal circumcision revealed that patients weighing >5.1 kg may be at higher risk of bleeding and long-term complications, such as adhesions.
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Affiliation(s)
- Jin K Kim
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Jessica M Ming
- Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Min Joon Lee
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Amre Kesavan
- Division of Urology, The Hospital for Sick Children, Toronto, Canada.,School of Medicine, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Megan Saunders
- Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
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Brook I. Genital Anaerobic Bacterial Overgrowth and the PrePex Male Circumcision Device, Rakai, Uganda. J Infect Dis 2016; 214:1125-6. [PMID: 27402778 DOI: 10.1093/infdis/jiw276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/20/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Itzhak Brook
- Departments of Pediatrics and Medicine, Georgetown University School of Medicine, Washington D.C
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