Life-threatening Escherichia coli cellulitis in patients with haematological malignancies

Necrotizing Skin and Soft Tissue Infection after Gluteal Augmentation in a Perioperatively Asymptomatic COVID-19 Patient-Complications of the Post-Lockdown Era? A Case Report

Introduction: Aesthetic surgery procedures are generally done in a relatively healthy population and carry a rather low risk compared to other surgical specialties. The incidence of complications in aesthetic surgery varies greatly depending on the type, wound cleanliness regarding the anatomical site, complexity of the surgery, patient's age, and comorbidities but is generally considered low. The overall incidence of surgical site infections (SSIs) in all aesthetic surgical procedures is around 1% in most of the literature while cases of necrotizing soft tissue infections are mostly found as individual reports. In contrast, treating COVID-19 patients is still challenging with many diverse outcomes. Surgical stress and general anesthesia are known mediators of cellular immunity impairment while studies regarding COVID-19 infection unquestionably have shown the deterioration of adaptive immunity by SARS-CoV-2. Adding COVID-19 to the modern surgical equation raises the question of immunocompetence in surgical patients. The main question of the modern post-lockdown world is: what could be expected in the postoperative period of perioperatively asymptomatic COVID-19 patients after aesthetic surgery? Case report: Here, we present a purulent, complicated, necrotizing skin and soft tissue infection (NSTI) after gluteal augmentation most likely triggered by SARS-CoV-2-induced immunosuppression followed by progressive COVID-19 pneumonia in an otherwise healthy, young patient. To the best of our knowledge, this is the first report of such adverse events in aesthetic surgery related to COVID-19. Conclusion: Aesthetic surgery in patients during the incubation period of COVID-19 or in asymptomatic patients could pose a significant risk for surgical complications, including severe systemic infections and implant loss as well as severe pulmonary and other COVID-19-associated complications.

Garlic and ginger essential oil-based neomycin nano-emulsions as effective and accelerated treatment for skin wounds' healing and inflammation: In-vivo and in-vitro studies

Skin, largest organ of human, is directly exposed to environment and hence is prone to high rates of injuries and microbial infections. Over the passage of time these microbes have developed resistance to antibiotics making them ineffective especially in lower doses and hence, higher dosages or new drugs are required. The current study deals with designing of nano-emulsion (NE) formulations composed of garlic and ginger oils (0.1 %) with neomycin sulphate used in different ratios (0.001, 0.01 and 0.1 %) and combinations. The resulting NEs were characterized for droplet size (145-304 nm), zetapotential (-3.0-0.9 mV), refractive index (1.331-1.344), viscosity (1.10-1.23cP), transmittance (96-99 %), FT-IR and HPLC and found stable over a period of three months. All NEs were also found effective against both gram positive and negative bacterial strains i.e., B. spizizenii, S. aureus, E. coli and S. enterica as compared to pure neomycin sulphate (NS) used as control with highest activity recorded for NE-2 and NE-4 against all strains showing zone of inhibition in range of 22-30 mm and 21-19 mm, respectively. NEs were also tested using rabbit skin excision wound model which potentiates that all the NEs resulted in early recovery with 86-100 % wound healing achieved in 9 days as compared to NS ointment (71 %). The studies confirmed that essential oils when used in combination with traditional drug can lead to much higher efficacies as compared to pure drugs.

Escherichia coli pyomyositis in a patient with Down syndrome: A case report

Pyomyositis is an infection of the skeletal muscle that involves intramuscular abscess formation. It is typically caused by gram-positive bacteria, especially Staphylococcus aureus. Few cases of Escherichia coli pyomyositis have been reported in immunocompromised adult patients, while none have been reported in children.

We present a case of a 4-year-old boy with Down syndrome who developed Escherichia coli pyomyositis. The patient presented to our hospital with a fever and right forearm swelling. The magnetic resonance imaging findings suggested pyomyositis of the right forearm muscle and osteomyelitis of the distal radius. Both the blood and puncture fluid cultures were negative. Cefazolin and vancomycin were administered, and his blood examination results and right forearm swelling improved; however, a slight fever persisted. The multiplex polymerase chain reaction isolated the chuA gene but not the YjaA gene; thus the patient was diagnosed with pyomyositis and osteomyelitis caused by Escherichia coli group D. The cefazolin was substituted with meropenem, and the vancomycin was discontinued. Thereafter, his fever promptly improved, which indicated that the cause of persistent fever was vancomycin drug fever. The patient was discharged after receiving 3 weeks of intravenous antimicrobial therapy, and recovered fully with no long-term sequelae.

To the best of our knowledge, this is the first reported case of Escherichia coli pyomyositis in a child. The findings in this case suggest that Escherichia coli should be considered when choosing initial empiric therapy for pyomyositis, especially in children with underlying conditions.

Cancer patients with neutropenic septic shock: etiology and antimicrobial resistance

BACKGROUND/AIMS

Among patients with febrile neutropenia that developed after chemotherapy, high-risk patients, such as those having clinical instability or Multinational Association of Supportive Care in Cancer score of < 21, require hospitalization for intravenous empiric antibiotic therapy. Monotherapy with an anti-pseudomonal ß-lactam agent is recommended. Although many studies reported the microbial etiology of infections and resistant patterns of febrile neutropenia, the patients were not well characterized as having neutropenic septic shock. Therefore, this study aimed to determine the microbial spectrum of infections and resistance patterns of their isolates in patients with chemotherapy-induced neutropenic septic shock.

METHODS

Data of adult patients diagnosed with neutropenic septic shock in the emergency department between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Thereafter, microbiological studies and antimicrobial susceptibility tests were conducted.

RESULTS

In total, 109 bacteria were found in patients with neutropenic septic shock. Gram-negative bacteria were the predominant causative organisms (84, 77.1%). Moreover, 33 microorganisms (30.3%) were multidrug-resistant (MDR) bacteria with extended-spectrum ß-lactamase-producing Escherichia coli (17, 50%) being the commonest. The most commonly affected sites in patients with MDR bacterial infections were the gastrointestinal tract (45%) and unknown (43.5%). Approximately 48.5% of MDR bacteria were resistant to cefepime but not to piperacillin-tazobactam or carbapenem.

CONCLUSION

MDR bacteria were prevalent in patients with chemotherapy-induced neutropenic septic shock. Therefore, piperacillin-tazobactam or carbapenem may be considered as empiric antibiotics if MDR bacteria are suspected to be causative agents.

Skin and Soft Tissue Infections

The skin is colonized by a diverse collection of microorganisms which, for the most part, peacefully coexist with their hosts. Skin and soft tissue infections (SSTIs) encompass a variety of conditions; in immunocompromised hosts, SSTIs can be caused by diverse microorganisms-most commonly bacteria, but also fungi, viruses, mycobacteria, and protozoa. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes or can be a manifestation of systemic disease. In immunocompromised hosts, SSTI poses a major diagnostic challenge, and clinical dermatological assessment should be initially performed; to better identify the pathogen and to lead to appropriate treatment, etiology should include cultures of lesions and blood, biopsy with histology, specific microbiological analysis with special stains, molecular techniques, and antigen-detection methodologies. Here, we reviewed the epidemiology, pathophysiology, clinical presentation, and diagnostic techniques, including molecular biological techniques, used for SSTIs, with a focus on the immunocompromised host, such as patients with cellular immunodeficiency, HIV, and diabetic foot infection.

Multidrug-resistant Escherichia coli soft tissue infection investigated with bacterial whole genome sequencing

A 45-year-old man with dilated cardiomyopathy presented with acute leg pain and erythema suggestive of necrotising fasciitis. Initial surgical exploration revealed no necrosis and treatment for a soft tissue infection was started. Blood and tissue cultures unexpectedly grew a Gram-negative bacillus, subsequently identified by an automated broth microdilution phenotyping system as an extended-spectrum β-lactamase producing Escherichia coli. The patient was treated with a 3-week course of antibiotics (ertapenem followed by ciprofloxacin) and debridement for small areas of necrosis, followed by skin grafting. The presence of E. coli triggered investigation of both host and pathogen. The patient was found to have previously undiagnosed liver disease, a risk factor for E. coli soft tissue infection. Whole genome sequencing of isolates from all specimens confirmed they were clonal, of sequence type ST131 and associated with a likely plasmid-associated AmpC (CMY-2), several other resistance genes and a number of virulence factors.