Soft tissue infections of the extremities in an orthopaedic centre in the UK

Nonvenomous Bite Injuries of the Foot: Case Reports and Review of the Literature

Animal bite injuries to humans are relatively common, however, bite injuries to the lower extremity and more specifically the foot are relatively uncommon. Foot injuries, once infected, may lead to further complications, such as soft tissue loss, bone loss, and the need for amputation. Patients with preexisting medical conditions, such as peripheral vascular disease and diabetes, are especially at risk for such complications. In this article, 2 recent cases are detailed and the literature to examine these injuries of the foot is reviewed.

Bisphosphonate–ciprofloxacin bound to Skelite™ is a prototype for enhancing experimental local antibiotic delivery to injured bone

Background

The risk of osteomyelitis after open bone fracture may be reduced by locally applied antibiotics. ENC-41-HP (E41), which comprises ciprofloxacin linked to a ‘bone seeking’ bisphosphonate, loaded on to carrier Skelite™ calcium phosphate granules (E41-Skelite™) has favourable in vitro characteristics for application to wounded bone. This study assessed E41-Skelite™ in a rat model of acute tibial osteomyelitis.

Methods

Mechanically induced tibial troughs were contaminated with approximately log10 4 colony forming units (c.f.u.) of Staphylococcus aureus (Cowan 1 strain) ‘resistant’ to E41 (minimum inhibitory concentration 8–16 µg/ml), lavaged and packed with Skelite™ alone, or with E41-Skelite™ slurry. Animals were killed at 24 h (n = 62), 72 h (n = 46) or 14 days (n = 12), and each tibia was assessed for S. aureus load (c.f.u./g tibia) and histological appearance (14 days only).

Results

At 24 and 72 h, the tibias of rats treated with E41-Skelite™ (n = 54) had a significantly lower mean(s.e.m.) load of S. aureus than animals that received Skelite™ alone (n = 54): log10 3·6(0·2) versus 6·4(0·1) c.f.u./g respectively at 24 h (P < 0·001, Mann–Whitney rank sum test) and log10 4·4(0·2) versus 6·6(0·1) c.f.u./g at 72 h (P < 0·001). At 14 days, E41-Skelite™-treated tibias had fewer bacteria, no signs of osteomyelitis and histological signs of healing.

Conclusion

E41-Skelite™, a prototype granulated topical antibiotic delivery system, reduced the development of infection in experimental bone wounds.

Isolation and molecular characterization of multiresistant Staphylococcus sciuri and Staphylococcus haemolyticus associated with skin and soft-tissue infections

The isolation, molecular identification and genotyping of multiresistant Staphylococcus sciuri and Staphylococcus haemolyticus from skin and soft-tissue infections are reported. Accurate and full identification of three coagulase-negative staphylococcal isolates was achieved using PCR, while the API STAPH method failed to identify an isolate of S. haemolyticus fully. The PCR assay, which detects polymorphism in the 16S-23S rRNA spacer region, is shown to be potentially useful for rapid and accurate identification of coagulase-negative staphylococci. Identical PFGE type and antibiotic-resistance profiles of two methicillin-resistant S. haemolyticus isolates in this study suggest the existence of a multiresistant community clone.