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Alhetheel AF, Alrfaei BM, Mujamammi AH, Hakami JA, Alshuhri AA. REGECEL (an Oxidized Regenerated Cellulose) Provides Superior Bioactivity Effect on Microorganisms. Infect Drug Resist 2024; 17:3353-3365. [PMID: 39131519 PMCID: PMC11317054 DOI: 10.2147/idr.s454539] [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: 12/12/2023] [Accepted: 07/13/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Patients who need to be readmitted to the hospital because of complications from infections or require long-term care and rehabilitation face substantial financial hardships. To ensure the safety of patients undergoing surgery, it is crucial to implement measures that prevent wound infections before and after the procedure. Antibacterial wound dressings are essential to prevent infections during surgical procedures. There are various types of antibacterial wound dressings available on the market, such as silver-based dressings, hydrocolloid dressings, polyhexamethylene biguanide, alginate dressings, collagen-based dressings, and iodine-based dressings. Methods We used each type (standard, knit, fibril, and non-woven) of a commercial brand of oxidized regenerated cellulose (ORC) called Regecel to test bacterial growth. The choice of antibacterial wound dressing depends on the type of wound being treated. Different bacterial strains require specific culture conditions to thrive and grow in laboratory settings. To obtain accurate and reliable results, it is vital to follow the precise culture conditions required for each bacterial strain. Results The evaluation of ORC highlighted its potential to inhibit bacterial growth, showing promising results against various bacterial strains and Candida albicans. Different variants of ORC, such as Regecel, have demonstrated impressive capacity to hinder the growth of 32 distinct bacterial strains, with inhibition rates ranging from 40-100%. These bacteria include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and penicillin-resistant Streptococcus pneumoniae. Conclusion This study supports the usage and development of ORC (Regecel) as an innovative approach to treating bacterial infections.
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Affiliation(s)
- Abdulkarim F Alhetheel
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bahauddeen M Alrfaei
- King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed H Mujamammi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jenadi A Hakami
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A Alshuhri
- Department of Research and Development, The National Medical Products Co, Ltd., Riyadh, Saudi Arabia
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2
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McNeil T, Coats J, Daniel S, Gordon D. Candida spp. Deep Sternal Wound Infections: A Consequence of Antibiotic use? Open Forum Infect Dis 2024; 11:ofae157. [PMID: 38595953 PMCID: PMC11002952 DOI: 10.1093/ofid/ofae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 04/11/2024] Open
Abstract
A cluster of deep sternal wound infections caused by Candida spp. occurred at our institution. Investigation did not disclose a common environmental source. We postulate that broad-spectrum antibiotic surgical prophylaxis and liberal use of antibiotics contributed to these infections.
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Affiliation(s)
- Thomas McNeil
- Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Joanna Coats
- Infection Prevention and Control Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Santhosh Daniel
- Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Gordon
- Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Microbiology and Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
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Diaddigo SE, LaValley MN, Kuonqui K, Janhofer DE, Ascherman JA. Flap management following orthotopic heart transplantation: A single institution's review of 66 sternal wound complications. J Plast Reconstr Aesthet Surg 2024; 90:266-272. [PMID: 38401198 DOI: 10.1016/j.bjps.2024.02.025] [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: 11/07/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Sternotomy wound complications are more frequent after orthotopic heart transplantation (OHT) compared to other cardiac surgeries, primarily due to additional risk factors, including immunosuppression. Flap closure often becomes necessary for definitive treatment, although there is a scarcity of data on the outcomes of sternal wound reconstruction in this specific population. METHODS A retrospective analysis was conducted on 604 sternal wound reconstructions performed by a single surgeon between 1996 and 2023. Inclusion criteria comprised patients who underwent OHT as their primary cardiac procedure. Surgical interventions involved sternal hardware removal, debridement, and muscle flap closure. RESULTS The study included 66 patients, with culture-positive wound infection being the most common indication for reconstruction (51.5%). The median duration between transplantation and sternal wound reconstruction was 25 days. Bilateral pectoralis major myocutaneous advancement flaps (n = 63), rectus abdominis flaps (n = 2), or pectoralis major turnover flaps (n = 1) were used. Intraoperative wound cultures revealed positivity in 48 patients (72.7%), with Staphylococcus epidermidis being the most frequently cultured organism (25.0%). The overall complication rate was 31.8%, and two patient deaths were related to sternal wounds, resulting from multiorgan failure following septic shock. The majority of the patients reported excellent long-term functional and esthetic outcomes. CONCLUSIONS Sternal wounds following OHT pose a significant morbidity risk. Our strategy focuses on immediate and aggressive antibiotic therapy, thorough debridement, and definitive closure with bilateral pectoralis myocutaneous advancement flaps. This approach has demonstrated complication and mortality rates comparable to the general cardiac surgery population, as well as excellent functional and esthetic results.
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Affiliation(s)
- Sarah E Diaddigo
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Myles N LaValley
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Kevin Kuonqui
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - David E Janhofer
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Jeffrey A Ascherman
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA.
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4
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Alves-Silva JM, Gonçalves MJ, Silva A, Cavaleiro C, Cruz MT, Salgueiro L. Chemical Profile, Anti-Microbial and Anti-Inflammaging Activities of Santolina rosmarinifolia L. Essential Oil from Portugal. Antibiotics (Basel) 2023; 12:antibiotics12010179. [PMID: 36671380 PMCID: PMC9854695 DOI: 10.3390/antibiotics12010179] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Fungal infections and the accompanying inflammatory responses are associated with great morbidity and mortality due to the frequent relapses triggered by an increased resistance to antifungal agents. Furthermore, this inflammatory state can be exacerbated during inflammaging and cellular senescence. Essential oils (EO) are receiving increasing interest in the field of drug discovery due to their lipophilic nature and complex composition, making them suitable candidates in the development of new antifungal drugs and modulators of numerous molecular targets. This work chemically characterized the EO from Santolina rosmarinifolia L., collected in Setúbal (Portugal), and assessed its antifungal potential by determining its minimum inhibitory (MIC) and minimum lethal (MLC) concentration in accordance with the Clinical Laboratory Standard Guidelines (CLSI) guidelines, as well as its effect on several Candida albicans virulence factors. The anti-inflammatory effect was unveiled using lipopolysaccharide (LPS)-stimulated macrophages by assessing several pro-inflammatory mediators. The wound healing and anti-senescence potential of the EO was also disclosed. The EO was mainly characterized by β-pinene (29.6%), borneol (16.9%), myrcene (15.4%) and limonene (5.7%). It showed a strong antifungal effect against yeasts and filamentous fungi (MIC = 0.07-0.29 mg/mL). Furthermore, it inhibited dimorphic transition (MIC/16), decreased biofilm formation with a preeminent effect after 24 h (MIC/2) and disrupted preformed biofilms in C. albicans. Additionally, the EO decreased nitric oxide (NO) release (IC50 = 0.52 mg/mL) and pro-IL-1β and inducible nitric oxide synthase (iNOS) expression in LPS-stimulated macrophages, promoted wound healing (91% vs. 81% closed wound) and reduced cellular senescence (53% vs. 73% β-galactosidase-positive cells). Overall, this study highlights the relevant pharmacological properties of S. rosmarinifolia, opening new avenues for its industrial exploitation.
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Affiliation(s)
- Jorge M. Alves-Silva
- Institute for Clinical and Biomedical Research, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal
| | - Maria José Gonçalves
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal
- Chemical Process Engineering and Forest Products Research Centre, Department of Chemical Engineering, Faculty of Sciences and Technology, University of Coimbra, 3030-790 Coimbra, Portugal
| | - Ana Silva
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
| | - Carlos Cavaleiro
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal
- Chemical Process Engineering and Forest Products Research Centre, Department of Chemical Engineering, Faculty of Sciences and Technology, University of Coimbra, 3030-790 Coimbra, Portugal
| | - Maria Teresa Cruz
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
| | - Lígia Salgueiro
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal
- Chemical Process Engineering and Forest Products Research Centre, Department of Chemical Engineering, Faculty of Sciences and Technology, University of Coimbra, 3030-790 Coimbra, Portugal
- Correspondence:
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Ge Y, Wang Q. Current research on fungi in chronic wounds. Front Mol Biosci 2023; 9:1057766. [PMID: 36710878 PMCID: PMC9874004 DOI: 10.3389/fmolb.2022.1057766] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
The occurrence of chronic wounds is a major global health issue. These wounds are difficult to heal as a result of disordered healing mechanisms. The most common types of chronic wounds are diabetic ulcers, pressure ulcers, arterial/venous ulcers and nonhealing surgical wounds. Although bacteria are an important cause of chronic nonhealing wounds, fungi also play a substantial role in them. The fungal infection rate varies with different chronic wound types, but overall, the prevalence of fungi is extremely underestimated in the clinical treatment and management of chronic wounds. Wounds and ulcers can be colonized by host cutaneous, commensal or environmental fungi and evolve into local infections, causing fungemia as well as invasive fungal disease. Furthermore, the fungi involved in nonhealing wound-related infections help commensal bacteria resist antibiotics and the host immune response, forcing wounds to become reservoirs for multiresistant species, which are considered a potential key factor in the microbial bioburden of wounds and ulcers. Fungi can be recalcitrant to the healing process. Biofilm establishment is the predominant mechanism of fungal resistance or tolerance to antimicrobials in chronic nonhealing wounds. Candida albicans yeast and Trichophyton rubrum filamentous fungi are the main fungi involved in chronic wound infection. Fungal species diversity and drug resistance phenotypes in different chronic nonhealing wound types will be emphasized. In this review, we outline the latest research on fungi in chronic wounds and discuss challenges and future perspectives related to diagnosing and managing chronic wounds.
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Affiliation(s)
- Yumei Ge
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China,Institute of Immunology, Zhejiang University, Hangzhou, China,The Key Laboratory for Immunity and Inflammatory Diseases of Zhejiang Province, Hangzhou, China,The Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang province, Hangzhou, China
| | - Qingqing Wang
- Institute of Immunology, Zhejiang University, Hangzhou, China,The Key Laboratory for Immunity and Inflammatory Diseases of Zhejiang Province, Hangzhou, China,*Correspondence: Qingqing Wang,
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Hariri G, Genoud M, Bruckert V, Chosidow S, Guérot E, Kimmoun A, Nesseler N, Besnier E, Daviaud F, Lagier D, Imbault J, Grimaldi D, Bouglé A, Mongardon N. Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome. Crit Care 2023; 27:6. [PMID: 36609390 PMCID: PMC9817255 DOI: 10.1186/s13054-022-04277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. METHODS Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009-2019). RESULTS Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17-61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43-65] vs. 65 [61-73] yo; p = 0.013), had lower body mass index (24 [20-26] vs. 30 [24-32] kg/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28-40] vs. 54 [34-61]; p = 0.012). CONCLUSION Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.
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Affiliation(s)
- Geoffroy Hariri
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.462844.80000 0001 2308 1657Institut Pierre Louis d’épidémiologie et de santé publique, Inserm U1136, Sorbonne Université, 75013 Paris, France
| | - Mathieu Genoud
- grid.150338.c0000 0001 0721 9812Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland
| | - Vincent Bruckert
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.410528.a0000 0001 2322 4179Service d’anesthésie-réanimation, CHU de Nice, 06000 Nice, France
| | - Samuel Chosidow
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Emmanuel Guérot
- grid.414093.b0000 0001 2183 5849Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000 Nancy, France
| | - Nicolas Nesseler
- grid.411154.40000 0001 2175 0984Service d’anesthésie-réanimation, CHU de Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284CHU de Rennes, Inra, Inserm, Institut NUMECAN – UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d’Investigation Clinique de Rennes), Univ Rennes, 35000 Rennes, France
| | - Emmanuel Besnier
- grid.41724.340000 0001 2296 5231Département d’anesthésie-réanimation, CHU de Rouen, 76000 Rouen, France ,grid.412043.00000 0001 2186 4076UNIROUEN, Inserm U1096, Normandie Univ, 76000 Rouen, France
| | - Fabrice Daviaud
- grid.417818.30000 0001 2204 4950Service de réanimation, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - David Lagier
- grid.411266.60000 0001 0404 1115Service d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13000 Marseille, France
| | - Julien Imbault
- grid.42399.350000 0004 0593 7118Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France ,grid.412041.20000 0001 2106 639XInserm, UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, 33000 Bordeaux, France
| | - David Grimaldi
- Service de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de Bruxelles, 1070 Brussels, Belgium
| | - Adrien Bouglé
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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Kuonqui K, Levy AS, Tiao JR, Altchek C, Ascherman JA. An Analysis of 400 Sternal Wound Reconstructions at a Single Institution: Bacterial Pathogens Vary With Time. Ann Plast Surg 2022; 88:S190-S193. [PMID: 35513317 DOI: 10.1097/sap.0000000000003172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sternal wound (SW) infection and dehiscence after median sternotomy from cardiac surgery remain challenging complications with high morbidity. Knowledge of common pathogen types and variance with time from cardiac surgery can simplify the choice of antibiotics while awaiting definitive culture results. METHODS Records of 505 patients undergoing SW reconstruction by the senior author from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. The most common indications for reconstruction were SW infection and dehiscence. At surgery, all patients underwent removal of sternal hardware, thorough debridement, and closure with bilateral pectoralis major myocutaneous advancement flaps. Deep tissue and bone cultures were sent in nearly all cases. Patients were split into group 1 or group 2 based on timing of flap reconstruction after initial cardiac surgery: 0 to 30 days and longer than 30 days, respectively. RESULTS Complete data were available for 400 SW procedures performed during this period. Group 1 included 203 patients, and group 2 had 197 patients, with a mean time to SW surgery of 16.3 and 138.1 days, respectively. Intraoperative cultures were positive in 147 of 203 (72.4%), and 122 of 197 (61.9%) patients, respectively. Forty-four patients grew polymicrobial cultures. There was a significant difference in culture positivity rates in the 2 groups (P = 0.0004). The most common bacteria cultured in group 1 was Staphylococcus epidermidis (54 of 203 vs 21 of 197; P < 0.0001), whereas methicillin-sensitive Staphylococcus aureus was most common in group 2 (15 of 203 vs 22 of 197; P = 0.23). Methicillin-resistant S. aureus was relatively common in both groups (17 of 203 vs 21 of 197; P = 0.50). Although not statistically significant, Pseudomonas, Klebsiella, and Candida were all found in a higher percentage of patients in group 2 (p = 0.11, 0.20, 0.20). CONCLUSIONS Microbial species cultured in SW flap reconstruction vary over time. Staphylococcus epidermidis is the most common infectious agent in patients having reconstruction within 30 days of cardiac surgery, whereas methicillin-sensitive S. aureus is most common after 30 days. The trend toward a higher incidence of Gram-negative and fungal organisms after 30 days may indicate a need for broader initial anti-infective coverage in this patient group. Awareness of these pathogen patterns can better inform antibiotic selection while awaiting culture data.
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Affiliation(s)
- Kevin Kuonqui
- From the Columbia University Vagelos College of Physicians and Surgeons
| | - Adam S Levy
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Jonathan R Tiao
- From the Columbia University Vagelos College of Physicians and Surgeons
| | - Chloe Altchek
- From the Columbia University Vagelos College of Physicians and Surgeons
| | - Jeffrey A Ascherman
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
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Mycobacterium tuberculosis Surgical Site Infection after Cardiac Surgery in the COVID-19 Era: A Case Report. Infect Dis Rep 2022; 14:101-105. [PMID: 35200440 PMCID: PMC8871775 DOI: 10.3390/idr14010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Infection of surgical wounds with acid-fast bacilli, including tubercle bacilli, is rare, and is poorly described in the literature. We present the case of a 74-year-old male who developed a sternal wound infection after cardiac surgery due to Mycobacterium tuberculosis complex, diagnosed post-mortem. SARS-CoV-2 infection contributed to worsened clinical conditions and surgical site infection. A high degree of suspicion to avoid unnecessary treatments and progression to severe disease with dismal prognosis is necessary in these types of infections.
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10
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Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, Hortal J, Lasso J, Mestres CA, Miró JM, Navas E, Nieto M, Parra A, Pérez de la Sota E, Rodríguez-Abella H, Rodríguez-Créixems M, Rodríguez-Roda J, Sánchez Espín G, Sousa D, Velasco García de Sierra C, Muñoz P, Kestler M. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections ( SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery ( SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases ( CIBERES). J Clin Med 2021; 10:5566. [PMID: 34884268 PMCID: PMC8658224 DOI: 10.3390/jcm10235566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | | | - Juan Gálvez
- Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Francisco Gutiérrez-Díez
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | - Javier Hortal
- Anesthesia and Intensive Care Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - José Lasso
- Plastic Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Carlos A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - José M. Miró
- Infectious Diseases Services, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Enrique Navas
- Infectious Diseases Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
| | - Mercedes Nieto
- Cardiovascular Unit, Intensive Care Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Antonio Parra
- Department of Radiology, Marquez de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | | | - Hugo Rodríguez-Abella
- Cardiac Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Marta Rodríguez-Créixems
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | - Gemma Sánchez Espín
- Heart Clinical Management Unit, Virgen de la Victoria University Hospital, 29006 Malaga, Spain;
| | - Dolores Sousa
- Infectious Diseases Department, A Coruña Hospital Complex, 15006 A Coruña, Spain;
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | - Martha Kestler
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
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11
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Moyon Q, Lebreton G, Huang F, Demondion P, Desnos C, Chommeloux J, Hékimian G, Bréchot N, Nieszkowska A, Schmidt M, Leprince P, Combes A, Luyt CE, Pineton de Chambrun M. Characteristics and outcomes of patients with postoperative Candida versus bacterial mediastinitis: a case-matched comparative study. Eur J Cardiothorac Surg 2021; 61:523-530. [PMID: 34662391 DOI: 10.1093/ejcts/ezab437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Postoperative mediastinitis, a feared complication after cardiac surgery, is associated with high mortality, especially of critically ill patients. Candida species infections are rare and severe, with poorly known outcomes. We conducted a case-control study to describe the characteristics, management and outcomes of patients with postoperative Candida mediastinitis. METHODS This French, monocentre, retrospective study included all patients with postoperative Candida mediastinitis (January 2003-February 2020) requiring intensive care unit admission. Candida mediastinitis patients (henceforth cases) were matched 1:1 with postoperative bacterial mediastinitis (henceforth control), based on 3 factors during mediastinitis management: age >40 years, cardiac transplantation and invasive circulatory device used. The primary end point was the probability of survival within 1 year after intensive care unit (ICU) admission. RESULTS Forty cases were matched to 40 controls. The global male/female ratio was 2.1, with mean age at admission 47.9 ± 13.8 years. Candida species were: 67.5% albicans, 17.5% glabrata, 15% parapsilosis, 5.0% tropicalis, 2.5% krusei and 2.5% lusitaniae. The median duration of mechanical ventilation was 23, 68.8% of patients received renal replacement therapy and 62.5% extracorporeal membrane oxygenation support. The probability of survival within the first year after ICU admission was 40 ± 5.5% and was significantly lower for cases than for controls (43 ± 8% vs 80 ± 6.3%, respectively; Log-rank test: P < 0.0001). The multivariable Cox proportional hazards model retained only renal replacement therapy [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.1-13.1; P = 0.04] and Candida mediastinitis (HR 2.4, 95% CI 1.1-5.6; P = 0.04) as independently associated with 1-year mortality. CONCLUSIONS Candida mediastinitis is a serious event after cardiac surgery and independently associated with 1-year mortality. Further studies are needed to determine whether deaths are directly attributable to Candida mediastinitis.
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Affiliation(s)
- Quentin Moyon
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Service de Médecine Interne, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
| | - Guillaume Lebreton
- Service de Chirurgie Cardiothoracique, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Florent Huang
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Pierre Demondion
- Service de Chirurgie Cardiothoracique, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Cyrielle Desnos
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Juliette Chommeloux
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Guillaume Hékimian
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Nicolas Bréchot
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Ania Nieszkowska
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Pascal Leprince
- Service de Chirurgie Cardiothoracique, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Service de Médecine Interne, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
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12
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Van Hemelrijck M, Frank M, Zinkernagel AS, Buechel R, Sromicki J, Wilhelm MJ, Klein H, Hasse B, Mestres CA. Sternectomy for Candida albicans sternal osteomyelitis after left ventricular assist device implantation. Indian J Thorac Cardiovasc Surg 2021; 37:573-576. [PMID: 34511767 PMCID: PMC8387541 DOI: 10.1007/s12055-021-01144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Fungal osteomyelitis is an uncommon complication after cardiac surgery and associated with high mortality. A case of Candida albicans and Staphylococcus epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a 60-year-old male patient is presented here. After clinical identification and confirmation with microbiological examinations and fluorodeoxyglucose positron emission tomography (FDG-PET) scan, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin, and negative pressure wound therapy were initiated, but failed to achieve healing. Total sternectomy and pectoralis flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.
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Affiliation(s)
- Mathias Van Hemelrijck
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Michelle Frank
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Ronny Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Juri Sromicki
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Markus J. Wilhelm
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Holger Klein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carlos A. Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
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13
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Meiwandi A, Zirngibl H, Bozkurt A. Candida albicans Osteochondromyelitis after Gastroesophageal Surgery: Two Case Reports. Indian J Plast Surg 2021; 54:232-234. [PMID: 34239253 PMCID: PMC8257295 DOI: 10.1055/s-0041-1731854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Candida osteochondromyelitis is a rare complication after thoracoabdominal surgery. We herein report two such cases after uncomplicated thoracoabdominal surgery, who presented with chronic postsurgical site infection and fistula. CT scans showed fistulas reaching the costochondral areas of the fifth rib. Inflammatory parameters were not elevated. Both patients were treated successfully after the initiation of systemic antimycotic treatment and surgical debridement. We conclude that C. albicans infections should always be considered in cases of chronic postoperative surgical site infections after thoracoabdominal surgery. Additional risk factors do not need to be present. Appropriate therapy consists of the application of systemic antimycotics and surgical debridement.
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Affiliation(s)
- Abdulwares Meiwandi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Hubert Zirngibl
- Division of Surgery II, Witten-Herdecke University, Wuppertal, Germany
| | - Ahmet Bozkurt
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
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14
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A New Antifungal-Loaded Sol-Gel Can Prevent Candida albicans Prosthetic Joint Infection. Antibiotics (Basel) 2021; 10:antibiotics10060711. [PMID: 34204833 PMCID: PMC8231561 DOI: 10.3390/antibiotics10060711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Fungal PJI is one of the most feared complications after arthroplasty. Although a rare finding, its high associated morbidity and mortality makes it an important object of study. The most frequent species causing fungal PJI is C. albicans. New technology to treat this type of PJI involves organic-inorganic sol-gels loaded with antifungals, as proposed in this study, in which anidulafungin is associated with organophosphates. This study aimed to evaluate the efficacy of an anidulafungin-loaded organic-inorganic sol-gel in preventing prosthetic joint infection (PJI), caused by Candida albicans using an in vivo murine model that evaluates many different variables. Fifty percent (3/6) of mice in the C. albicans-infected, non-coated, chemical-polished (CP)-implant group had positive culture and 100% of the animals in the C. albicans-infected, anidulafungin-loaded, sol-gel coated (CP + A)-implant group had a negative culture (0/6) (p = 0.023). Taking the microbiology and pathology results into account, 54.5% (6/11) of C. albicans-infected CP-implant mice were diagnosed with a PJI, whilst only 9.1% (1/11) of C. albicans-infected CP + A-implant mice were PJI-positive (p = 0.011). No differences were observed between the bone mineral content and bone mineral density of noninfected CP and noninfected CP + A (p = 0.835, and p = 0.181, respectively). No histological or histochemical differences were found in the tissue area occupied by the implant among CP and CP + A. Only 2 of the 6 behavioural variables evaluated exhibited changes during the study: limping and piloerection. In conclusion, the anidulafungin-loaded sol-gel coating showed an excellent antifungal response in vivo and can prevent PJI due to C. albicans in this experimental model.
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15
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Lin X, Mao Y, Li P, Bai Y, Chen T, Wu K, Chen D, Yang H, Yang L. Ultra-Conformable Ionic Skin with Multi-Modal Sensing, Broad-Spectrum Antimicrobial and Regenerative Capabilities for Smart and Expedited Wound Care. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2004627. [PMID: 33977071 PMCID: PMC8097371 DOI: 10.1002/advs.202004627] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/29/2020] [Indexed: 05/18/2023]
Abstract
While rapid wound healing is essential yet challenging, there is also an unmet need for functional restoration of sensation. Inspired by natural skin, an ultra-conformable, adhesive multi-functional ionic skin (MiS) with multi-modal sensing capability is devised for smart and expedited wound care. The base of MiS is a unique skin-like, conductive and self-adaptive adhesive polyacrylamide/starch double-network hydrogel (PSH) and self-powered, flexible, triboelectric sensor(s) is integrated on top of PSH for multi-tactile sensing. MiS could enhance wound contraction, collagen deposition, angiogenesis, and epidermis formation in a full-thickness skin defect wound model in vivo, while significantly inhibiting the biofilm formation of a wide range of microorganisms. MiS also exhibits multi-modal sensing capability for smart and instant therapeutics and diagnostics, including skin displacement or joint motion, temperature, pressure and tissue exudate changes of wound bed, and locally releasing drugs in a pH-responsive manner. More importantly, MiS could restore the skin-mimicking tactile sensing function of both touch location and intensity, and thus could be used as a human-machine interface for accurate external robotic control. MiS demonstrates a new comprehensive paradigm of combining wound diagnosis and healing, broad-spectrum anti-microbial capability and restoration of multi-tactile sensing for the reparation of severe wound.
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Affiliation(s)
- Xiao Lin
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Yuxuan Mao
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Peng Li
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Yanjie Bai
- School of Public HealthSoochow UniversitySuzhou215123P. R. China
| | - Tao Chen
- Jiangsu Provincial Key Laboratory of Advanced Robotics, School of Mechanical and Electric EngineeringSoochow UniversitySuzhou215123P. R. China
| | - Kang Wu
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Dandan Chen
- National Institute for Food and Drug ControlBeijing102629P. R. China
| | - Huilin Yang
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Lei Yang
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
- Center for Health Science and Engineering (CHSE), School of Materials Science and EngineeringHebei University of TechnologyTianjin300130P. R. China
- Tianjin Key Laboratory of Spine and Spinal CordTianjin Medical University General HospitalTianjin300130P. R. China
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16
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Penetration of echinocandins into wound secretion of critically ill patients. Infection 2021; 49:747-755. [PMID: 33877638 PMCID: PMC8316195 DOI: 10.1007/s15010-021-01604-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/08/2021] [Indexed: 01/12/2023]
Abstract
Purpose Wound infections caused by Candida are life-threatening and difficult to treat. Echinocandins are highly effective against Candida species and recommended for treatment of invasive candidiasis. As penetration of echinocandins into wounds is largely unknown, we measured the concentrations of the echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS) in wound secretion (WS) and in plasma of critically ill patients. Methods We included critically ill adults with an indwelling wound drainage or undergoing vacuum-assisted closure therapy, who were treated with an echinocandin for suspected or proven invasive fungal infection. Concentrations were measured by liquid chromatography with UV (AFG and MFG) or tandem mass spectrometry detection (CAS). Results Twenty-one patients were enrolled. From eight patients, serial WS samples and simultaneous plasma samples were obtained within a dosage interval. AFG concentrations in WS amounted to < 0.025–2.25 mg/L, MFG concentrations were 0.025–2.53 mg/L, and CAS achieved concentrations of 0.18–4.04 mg/L. Concentrations in WS were significantly lower than the simultaneous plasma concentrations and below the MIC values of some relevant pathogens. Conclusion Echinocandin penetration into WS displays a high inter-individual variability. In WS of some of the patients, concentrations may be sub-therapeutic. However, the relevance of sub-therapeutic concentrations is unknown as no correlation has been established between concentration data and clinical outcome. Nevertheless, in the absence of clinical outcome studies, our data do not support the use of echinocandins at standard doses for the treatment of fungal wound infections, but underline the pivotal role of surgical debridement. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01604-x.
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17
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Papachristou SG, Iosifidis E, Sipsas NV, Gamaletsou MN, Walsh TJ, Roilides E. Management of osteoarticular fungal infections in the setting of immunodeficiency. Expert Rev Anti Infect Ther 2020; 18:461-474. [PMID: 32213145 DOI: 10.1080/14787210.2020.1748499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Osteoarticular fungal infections (OAFIs) complicate the clinical course of high-risk patients, including immunosuppressed individuals. Their management, however, despite being intricate, is governed by evidence arising from sub-optimal quality research, such as case series. Guidelines are scarce and when present result in recommendations based on low quality evidence. Furthermore, the differences between the management of immunocompromised and immunocompetent patients are not distinct. This is a narrative review after a literature search in PubMed, up to November 2019.Areas covered: The major fungal groups causing osteomyelitis and/or arthritis are Candida spp., Aspergillus spp., non-Aspergillus filamentous fungi, non-Candida yeasts and endemic dimorphic fungi. Their epidemiology is briefly analyzed with emphasis on immunodeficiency and other risk factors. Management of OAFIs includes appropriate antifungal drug therapy (liposomal amphotericin B, triazoles or echinocandins), local surgery and immunotherapy for primary immunodeficiencies. Cessation of immunosuppressive drugs is also mandated.Expert opinion: Management of OAFIs includes affordable and available options and approaches. However, research on therapeutic practices is urgently required to be further improved, due to the rarity of affected patients. Evolution is expected to translate into novel antifungal drugs, less invasive and precise surgical approaches and targeted enhancement of immunoregulatory pathways in defense of challenging fungal pathogens.
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Affiliation(s)
- Savvas G Papachristou
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria N Gamaletsou
- Infectious Diseases Unit, Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas J Walsh
- Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, New York, NY, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
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18
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Arıkan AA, Omay O, Kanko M, Horuz E, Yağlı G, Kağan EY, Ağır H. Treatment of Candida sternal infection following cardiac surgery - a review of literature. Infect Dis (Lond) 2018; 51:1-11. [PMID: 30264627 DOI: 10.1080/23744235.2018.1518583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Candida sternal wound infections (SWIs) following cardiac surgery are rare but are associated with a high mortality rate. Guidelines on this topic either propose no suggestions for management or offer recommendations based on a small number of reports. METHODS This paper presents a case of a Candida SWI and its successful treatment with debridement using a burr, negative pressure vacuum therapy (NPVT) and dermal grafting. To investigate different methods of treating Candida SWIs following cardiac surgery, a review was completed using the MEDLINE database. Reports without English abstracts and without defined outcomes of therapy for individual patients were excluded. RESULTS Seventy-seven cases of Candida SWIs following cardiac surgery were identified in 20 articles published since 1999, including our case. Treatment strategies are identified: omentum flap; muscle flap; debridement and secondary wound healing with or without NPVT; debridement and primary closure; incision and drainage; only medical therapy. Patients documented in the articles were classified based on the following outcomes: cured (n = 41 patients [including the present case]), relapse infection (n = 25 patients) and death (n = 11 patients). The various methods used to treat patients were analysed. CONCLUSIONS Delayed closure reoperation with surgical debridement and NPVT have favourable outcomes. In the presence of widespread osteomyelitis, the use of omental flaps is advocated. Treatment with muscle flaps has a high rate of relapse. Debridement and secondary healing or conservative management with antifungals alone can be considered in the treatment of relapsing infection.
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Affiliation(s)
- Ali Ahmet Arıkan
- a Department of Cardiovascular Surgery , Muş State Hospital , Muş , Turkey
| | - Oğuz Omay
- b Kocaeli University Medical Faculty , Department of Cardiovascular Surgery , Kocaeli , Turkey
| | - Muhip Kanko
- b Kocaeli University Medical Faculty , Department of Cardiovascular Surgery , Kocaeli , Turkey
| | - Emre Horuz
- c Department of Infectious Diseases and Clinical Microbiology , Zonguldak Hospital for Obstetrics and Pediatric Diseases , Zonguldak , Turkey
| | - Gökhan Yağlı
- b Kocaeli University Medical Faculty , Department of Cardiovascular Surgery , Kocaeli , Turkey
| | - Emrah Yaşar Kağan
- d Department of Plastic and Reconstructive Surgery , Kocaeli University Medical Faculty , Kocaeli , Turkey
| | - Hakan Ağır
- e Department of Plastic and Reconstructive Surgery , Altunizade Acıbadem Hospital , İstanbul , Turkey
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Ju T, Rivas L, Sarani B. Successful Surgical Stabilization of Rib Fractures Despite Candida Colonization of the Mediastinum. Ann Thorac Surg 2018; 106:e121-e123. [PMID: 29630876 DOI: 10.1016/j.athoracsur.2018.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/27/2018] [Accepted: 03/04/2018] [Indexed: 02/04/2023]
Abstract
Pleural space or chest wall infection is a contraindication to surgical stabilization of rib fractures (SSRF) because of the risk of hardware infection. However, the exact degree of risk is uncertain. SSRF is associated with a decreased need for mechanical ventilation and pneumonia. This case report describes a patient with polytrauma and Candida colonization of the mediastinum who successfully underwent SSRF.
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Affiliation(s)
- Tammy Ju
- Department of General Surgery, The George Washington University Hospital, Washington, DC.
| | - Lisbi Rivas
- Department of General Surgery, The George Washington University Hospital, Washington, DC
| | - Babak Sarani
- Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC
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Gaining Insights from Candida Biofilm Heterogeneity: One Size Does Not Fit All. J Fungi (Basel) 2018; 4:jof4010012. [PMID: 29371505 PMCID: PMC5872315 DOI: 10.3390/jof4010012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 12/17/2022] Open
Abstract
Despite their clinical significance and substantial human health burden, fungal infections remain relatively under-appreciated. The widespread overuse of antibiotics and the increasing requirement for indwelling medical devices provides an opportunistic potential for the overgrowth and colonization of pathogenic Candida species on both biological and inert substrates. Indeed, it is now widely recognized that biofilms are a highly important part of their virulence repertoire. Candida albicans is regarded as the primary fungal biofilm forming species, yet there is also increasing interest and growing body of evidence for non-Candida albicans species (NCAS) biofilms, and interkingdom biofilm interactions. C. albicans biofilms are heterogeneous structures by definition, existing as three-dimensional populations of yeast, pseudo-hyphae, and hyphae, embedded within a self-produced extracellular matrix. Classical molecular approaches, driven by extensive studies of laboratory strains and mutants, have enhanced our knowledge and understanding of how these complex communities develop, thrive, and cause host-mediated damage. Yet our clinical observations tell a different story, with differential patient responses potentially due to inherent biological heterogeneity from specific clinical isolates associated with their infections. This review explores some of the recent advances made in an attempt to explore the importance of working with clinical isolates, and what this has taught us.
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First line treatment of Candida osteomyelitis of the sternum: Is there really a need for radical surgical debridement and reconstructive surgery in Candida osteomyelitis of the sternum after cardiac surgery? J Plast Reconstr Aesthet Surg 2017; 70:291-292. [DOI: 10.1016/j.bjps.2016.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/16/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
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van Wingerden JJ, de Mol BAJM, van der Horst CMAM. Defining post-sternotomy mediastinitis for clinical evidence-based studies. Asian Cardiovasc Thorac Ann 2016; 24:355-63. [DOI: 10.1177/0218492316639405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Considerable advances have already been made in the treatment of deep thoracic wound infections following a median sternotomy for cardiac surgery. Further improvement in diagnosis, treatment, and outcome will require a targeted approach by multidisciplinary teams. Clear communication and synergy between the various clinical and supportive disciplines would assist in removing the last barriers to standardized evidence-based studies and the development of improved evidence-based guidelines. Methods An extensive literature search without language restrictions was carried out on PubMed (Medline), EMBASE, and Web of Science, covering the period 1988 to week 16, 2014, and a manual search of the reference lists was performed regarding all possible definitions and classifications of post-sternotomy mediastinitis. Two hundred and eighteen papers describing post-sternotomy infections in a multitude of terms were identified, and the strengths and weaknesses of the most popular definitions and terms relating specifically to post-sternotomy infections were examined. Results This study revealed that clinicians use a multitude of terms to describe post-sternotomy infections without defining the condition under treatment. Occasionally, older epidemiological (surveillance) definitions were used. It also shows that supportive disciplines have their own definitions, or interpretations of existing definitions, to describe these infections. Conclusion The outcome of this study is that clinicians have adopted no single definition, which is essential for further improvement for evidence-based studies. We suggest that it is possible to adopt a single term for thoracic infection after a sternotomy (and only sternotomy), and propose a clinical definition for this purpose.
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Affiliation(s)
- Jan J van Wingerden
- Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Bas AJM de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Chantal MAM van der Horst
- Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
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Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1-50. [PMID: 26679628 PMCID: PMC4725385 DOI: 10.1093/cid/civ933] [Citation(s) in RCA: 1888] [Impact Index Per Article: 236.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
| | - Carol A Kauffman
- Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor
| | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Thomas J Walsh
- Weill Cornell Medical Center and Cornell University, New York, New York
| | | | - Jack D Sobel
- Harper University Hospital and Wayne State University, Detroit, Michigan
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Nowicki JL, Dean NR, Watson DI. A Case Report of Candida albicans Costochondritis after a Complicated Esophagectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e608. [PMID: 27104107 PMCID: PMC4801093 DOI: 10.1097/gox.0000000000000599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022]
Abstract
We present an unusual case of Candida albicans costochondritis after a complicated Ivor Lewis esophagectomy. This case exhibits that pain, erythema, and swelling over the costal cartilages should alert the possibility of infective costochondritis, especially in a postoperative patient. If a fungal agent is identified, aggressive surgical debridement and early commencement of antifungal therapy are likely determinants for a satisfactory outcome.
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Affiliation(s)
- Jake L Nowicki
- Department of Surgery, Flinders University, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia; and Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicola R Dean
- Department of Surgery, Flinders University, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia; and Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David I Watson
- Department of Surgery, Flinders University, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia; and Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
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Magano R, Cortez J, Ramos E, Trindade L. Candida albicans osteomyelitis as a cause of chest pain and visual loss. BMJ Case Rep 2015; 2015:bcr-2015-211327. [PMID: 26475877 DOI: 10.1136/bcr-2015-211327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.
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Affiliation(s)
- Rita Magano
- Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal
| | - Joana Cortez
- Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal
| | | | - Luís Trindade
- Department of Infectious Disease, Coimbra's Hospital Centre and University, Coimbra, Portugal
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26
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Prevost N, English JC. Candida rib osteomyelitis: Erythema and nodule in midline scar. J Am Acad Dermatol 2013; 69:e205-7. [DOI: 10.1016/j.jaad.2013.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/06/2013] [Accepted: 06/09/2013] [Indexed: 11/24/2022]
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Cervera C. Candidemia y candidiasis invasora en el adulto. Formas clínicas y tratamiento. Enferm Infecc Microbiol Clin 2012; 30:483-91. [DOI: 10.1016/j.eimc.2012.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/10/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
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Gamaletsou MN, Kontoyiannis DP, Sipsas NV, Moriyama B, Alexander E, Roilides E, Brause B, Walsh TJ. Candida osteomyelitis: analysis of 207 pediatric and adult cases (1970-2011). Clin Infect Dis 2012; 55:1338-51. [PMID: 22911646 DOI: 10.1093/cid/cis660] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. METHODS Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. RESULTS Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90%) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90% of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67%), direct inoculation (25%), and contiguous infection (9%). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95% confidence interval [CI], .04-.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95% CI, 8.4-48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35% of cases. Bacteria were recovered concomitantly from 12% of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21%. Combined surgery and antifungal therapy were used in 48% of cases. The overall complete response rate of Candida osteomyelitis of 32% reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32% who ultimately achieved complete response. CONCLUSIONS Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6-12 months of antifungal therapy, and surgical intervention, when indicated, may improve outcome.
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Affiliation(s)
- Maria N Gamaletsou
- Division of Infectious Diseases, Weill Cornell Medical Center of Cornell University, New York, NY 10065, USA
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Johnson B, Davis J, Sisneros M. Mediastinitis: Could your case be a candidate for candida? AMERICAN JOURNAL OF CASE REPORTS 2012; 13:86-8. [PMID: 23569496 PMCID: PMC3615916 DOI: 10.12659/ajcr.882856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 05/10/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Candida mediastinitis is rare, but mortality has been reported as high as 50%. There are no clinical trials evaluating treatment of Candida mediastinitis and there are only a limited number of reports in the literature. CASE REPORT We present two cases of mediastinitis after coronary artery bypass grafting due to Candida albicans. Immunosuppression and long surgical procedures were likely risk factors for the infections. After multiple hospitalizations and debridements there was concern for the development of resistance. However, the isolates were determined to be fluconazole-susceptible and the patients were treated with long-term oral fluconazole. CONCLUSIONS Candida mediastinitis is difficult to treat. Even with appropriate treatment, patients may require numerous surgical debridements.
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Affiliation(s)
- Bernadette Johnson
- University of New Mexico, Health Sciences Center, Albuquerque, NM, U.S.A
| | - Joshua Davis
- University of New Mexico, Health Sciences Center, Albuquerque, NM, U.S.A
| | - Maria Sisneros
- New Mexico Veterans Affairs Health Care System, NM, U.S.A
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30
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Marchiori E, Dalston M, Zanetti G, Hochhegger B. Paracoccidioidomycosis: Another cause of sternal osteomyelitis. Joint Bone Spine 2012; 79:323-4. [DOI: 10.1016/j.jbspin.2011.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/05/2011] [Indexed: 11/25/2022]
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Osada H, Nakajima H, Morishima M, Su T. Candidal mediastinitis successfully treated using vacuum-assisted closure following open-heart surgery. Interact Cardiovasc Thorac Surg 2012; 14:872-4. [PMID: 22422875 DOI: 10.1093/icvts/ivs084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Deep sternal wound infections (DSWIs) are an uncommon but serious complication after open-heart surgery. The reported incidence of DSWIs due to Candida albicans is 0.4%, but these infections have an extremely high mortality of 56%. We herein report a rare case of a 79-year old woman who suffered from Candidal DSWI after repeated open-heart surgeries. We treated her with negative pressure wound therapy (NPWT). This is the rare case report that provides evidence that NPWT is a safe and suitable technique for the management of Candidal DSWIs.
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Affiliation(s)
- Hiroaki Osada
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan.
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Dohmen PM, Weymann A, Holinski S, Linneweber J, Geyer T, Konertz W. Use of an Antimicrobial Skin Sealant Reduces Surgical Site Infection in Patients Undergoing Routine Cardiac Surgery. Surg Infect (Larchmt) 2011; 12:475-81. [DOI: 10.1089/sur.2011.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Pascal M. Dohmen
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Department of Cardiovascular Surgery, Medical University Berlin, Berlin, Germany
| | - Alexander Weymann
- Department of Cardiovascular Surgery, Medical University Berlin, Berlin, Germany
| | - Sebastian Holinski
- Department of Cardiovascular Surgery, Medical University Berlin, Berlin, Germany
| | - Jörg Linneweber
- Department of Cardiovascular Surgery, Medical University Berlin, Berlin, Germany
| | - Torsten Geyer
- Department of Anesthesiology, Charité Hospital, Medical University Berlin, Berlin, Germany
| | - Wolfgang Konertz
- Department of Cardiovascular Surgery, Medical University Berlin, Berlin, Germany
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Emerging role of Candida in deep sternal wound infection. Ann Thorac Surg 2010; 88:1905-9. [PMID: 19932259 DOI: 10.1016/j.athoracsur.2009.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study evaluated the overall incidence, prognosis, and risk factors for microbiologically documented Candida deep sternal wound infection (DSWI) after cardiac operations. METHODS A retrospective observational study was performed at Aalborg Hospital, Aarhus University Hospital, Denmark, from January 1999 through November 2006. Included were all 83 of 4222 cardiac surgical patients with microbiologically documented DSWI requiring surgical revision. Various potential risk factors in patients with Candida DSWI were compared with those of patients with non-Candida DSWI. We compared markers of morbidity, in-hospital mortality, and 1-year mortality to evaluate the prognosis of the disease. RESULTS DSWI developed in 2% of all patients, of whom, 17 (20.5%) had Candida DSWI, and 66 (79.5%) had non-Candida etiology. Candida was the primary causative organism in 11 of 17 Candida DSWI cases. No Candida DSWI was found during the first 3 years of the study. In-hospital and 1-year mortality were doubled in patients with Candida DSWI compared with patients with non-Candida DSWI. Candida DSWI was associated with significantly longer stay in the intensive care unit and need of prolonged mechanical ventilation. Risk factors for Candida etiology were Candida colonization in tracheal secretions or urine and reoperation before diagnosis of DSWI. CONCLUSIONS Candida was a frequent causative agent of DSWI in our series and was associated with a very high morbidity and mortality. Cardiothoracic patients on mechanical ventilation when colonized with Candida were identified as a high-risk population for subsequent development of Candida DSWI.
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Primary sternal osteomyelitis in a 40 days old infant: a case report and review of the literature. CASES JOURNAL 2009; 2:7504. [PMID: 19829981 PMCID: PMC2740258 DOI: 10.4076/1757-1626-2-7504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Accepted: 04/20/2009] [Indexed: 11/16/2022]
Abstract
Introduction Primary sternal osteomyelitis is extremely rare in children and only very few cases have been reported in the international literature. Case presentation A 40 days old Caucasian infant was referred to our clinic with a 4 days history of fever and malaise, accompanying a painful swelling of four days duration involving the lower end of the sternum. Examination revealed a 2 cm swelling which was fixed to the underlying bone. A full blood count, erythrocyte sedimentation rate, and C-reactive protein were measured and x-rays (Anterior and Lateral views) and Ultrasound was performed. Blood cultures were also taken. The patient was commenced empirically to Vancomycin and Cefotaxime intravenously. The values of White Blood Cell (16,720), erythrocyte sedimentation rate (132 mm) and C-reactive protein (108 mg/dl) were elevated, the X-rays showed bone destruction and dislocation of the 3rd sternal nuclei and in the U/S performed appeared a soft tissue mass measuring 2,37/1,02 cm related to the periosteum. Surgical debridement was then performed and swab cultures were taken intraoperatively. The infant grew Streptococcus Pneumoniae and Enterococcus Species. The infant was discharged after 25 days from the hospital. He gradually improved over a period of 2 months, became pain free and repeated x-rays showed significant bone resolution. Conclusion Primary osteomyelitis in infants is a very rare condition that usually resolves with antibiotic therapy and surgical debridement.
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Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503-35. [PMID: 19191635 PMCID: PMC7294538 DOI: 10.1086/596757] [Citation(s) in RCA: 2011] [Impact Index Per Article: 134.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.
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Affiliation(s)
- Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.
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Hollenbach E. Invasive candidiasis in the ICU: evidence based and on the edge of evidence. Mycoses 2008; 51 Suppl 2:25-45. [DOI: 10.1111/j.1439-0507.2008.01571.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Sica G, Meissner S, Dawas K, Maynard N. Candida osteo-chondromyelitis complicating thoraco-abdominal esophageal surgery. Surg Infect (Larchmt) 2007; 8:479-82. [PMID: 17883365 DOI: 10.1089/sur.2006.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Candida albicans osteo-costochondromyelitis is a rare condition. Such pathology after esophagectomy has not been reported. METHODS Report of four cases and review of pertinent English-language literature. RESULTS Four patients underwent esophageal surgery via a left thoraco-abdominal approach between June, 1999 and March, 2000. After complicated post-operative courses, Candida osteomyelitis of the costochondral margin presented initially as a cutaneous sinus. CONCLUSIONS All patients responded well to surgical debridement followed by a three-month course of oral fluconazole.
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Affiliation(s)
- Giuseppe Sica
- Department of Upper Gastrointestinal Surgery, John Radcliffe Hospital, Oxford, United Kingdom
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38
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Sims CR, Ostrosky-Zeichner L, Rex JH. Invasive Candidiasis in Immunocompromised Hospitalized Patients. Arch Med Res 2005; 36:660-71. [PMID: 16216647 DOI: 10.1016/j.arcmed.2005.05.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 05/24/2005] [Indexed: 11/17/2022]
Abstract
The frequency of infections by Candida species is increasing worldwide, with candidemia representing the fourth most common bloodstream infection in the U.S. The risk of infection is especially high in the immunocompromised, hospitalized patient. The treatment of and prophylaxis for Candida infection have led to the emergence of resistant species and the acquisition of resistance in previously susceptible species. Current therapeutic options include amphotericin B and its lipid compounds, fluconazole, itraconazole, voriconazole, and caspofungin. Research is focusing on better diagnostics and the evaluation of strategies such as prophylaxis in high-risk hosts and pre-emptive therapy.
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Affiliation(s)
- Charles R Sims
- Laboratory of Mycology Research, Division of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
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Upadhyaya M, Keil A, Thonell S, Orford J, Burgner D. Primary sternal osteomyelitis: a case series and review of the literature. J Pediatr Surg 2005; 40:1623-7. [PMID: 16226995 DOI: 10.1016/j.jpedsurg.2005.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary sternal osteomyelitis is rare in the pediatric population. METHODS We present 4 recent cases that demonstrate a wide range in age, presenting features, and clinical course, and we performed a literature review. RESULT A combination of diagnostic aspiration with prolonged appropriate antibiotic therapy led to successful resolution in all cases. Surgical debridement should be reserved for cases that do not respond to medical therapy. CONCLUSION Sternal osteomyelitis is a rare condition in children that usually resolves with aspiration and prolonged antibiotic therapy.
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Affiliation(s)
- Manasvi Upadhyaya
- Department of Paediatric Surgery, Princess Margaret Hospital, Australia
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40
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Arias F, Mata-Essayag S, Landaeta ME, Capriles CHD, Pérez C, Núñez MJ, Carvajal A, Silva M. Candida albicans osteomyelitis: case report and literature review. Int J Infect Dis 2004; 8:307-14. [PMID: 15325600 DOI: 10.1016/j.ijid.2003.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Revised: 10/11/2003] [Accepted: 12/28/2003] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Osteomyelitis due to Candida species is an unusual but recognized entity. However, with the increasing occurrence of factors predisposing to candidemia and invasive candidiasis, candidal osteomyelitis is being diagnosed more frequently. An unusual case of Candida albicans osteomyelitis is reported here, along with a review of the published literature on previously reported cases of this disease. METHODS Report of the case and literature review. RESULTS In this case, Candida albicans was isolated from the talus; however, the diagnosis was made after several cultures were performed. Only one other case of Candida osteomyelitis located in foot bones was found in the review. CONCLUSIONS It is thought that this is the first case reported in Venezuela, and only the second in international literature.
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Affiliation(s)
- Félix Arias
- Servicio de Enfermedades Infecciosas del Adulto, Hospital Universitario de Caracas, Venezuela
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Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE. Guidelines for Treatment of Candidiasis. Clin Infect Dis 2004; 38:161-89. [PMID: 14699449 DOI: 10.1086/380796] [Citation(s) in RCA: 910] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Accepted: 09/12/2003] [Indexed: 11/03/2022] Open
Affiliation(s)
- Peter G Pappas
- Division of Infectious Diseases, University of Alabama at Birmingham, Alabama 35294-0006, USA.
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