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1/26. amikacin (BBK8) in infections due to gram-negative organisms in children over the age of one month.

    Thirty children over the age of one month were treated with amikacin (BBK8), a new aminoglycoside derived from kanamycin A, with three intramuscular dosage schedules. Each group consisted of ten patients. The first received 7-5 mg/kg/12 hours, the second 7-5 mg/kg/24 hours and the third, 3-75 mg/kg/12 hours. The infections and the bacteria were similar in all three groups: pyelonephritis, abscesses of soft tissues, infected wounds, septicaemia, superinfected empyema, gastro-enteritis, chronic otitis media; the bacteria were E. coli, klebsiella, pseudomonas and salmonella. A were sensitive by the Kirby-Bauer method, although two were resistant by dilution in Petri dish. Of the thirty patients, twenty four (80%) were cured. The schedule of 3-75 mg/kg/12 hours was as effective as the schedule of 7-5 mg/kg/12 hours for infections such as pyelonephritis, superficial abscesses, contaminated wounds, gastro-enteritis and sepsis. The cases with infections localized in rather unaccessible sites required double the dose and strict drainage and cleanliness. plasma levels with the administration of 3-75 mg/kg fluctuated between 8-3 and 12-6 mcg/ml; with 7-5 mg/kg they fluctuated between 8-6 and 13-1. The minimum inhibitory level (MIL) for the majority of the bacteria was 1-25 mcg/ml. No toxic reactions were observed.
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keywords = wound
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2/26. Subdural empyema complicating cerebrospinal fluid shunt infection.

    Subdural empyema has not been reported previously as a complication of cerebrospinal fluid (CSF) shunt surgery. An infant submitted to CSF shunt insertion for congenital hydrocephalus developed subdural empyema after a failed attempt to treat a superficial scalp wound infection with oral antibiotics. enterobacter cloacae was isolated from the empyema. Temporizing management of the preceding superficial wound infection with oral antibiotics probably was the cause of this exotic pathogen. The treatment of infected scalp wounds contiguous with shunt hardware must be surgical.
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ranking = 138.99902174437
keywords = wound infection, wound
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3/26. Outbreak of nosocomial infections due to extended-spectrum beta-lactamase-producing strains of enteric group 137, a new member of the family enterobacteriaceae closely related to citrobacter farmeri and citrobacter amalonaticus.

    A member of the enterobacteriaceae initially identified as kluyvera cryocrescens by the MicroScan Gram-Negative Combo 13 panel caused an outbreak of nosocomial infections in four patients (pneumonia, n = 2; urinary tract infection, n = 1; wound infection, n = 1) and urinary tract colonization in one patient. When the strains were tested by the Enteric Reference Laboratory of the Centers for disease Control and Prevention, biochemical results were most compatible with yersinia intermedia, kluyvera cryocrescens, and citrobacter farmeri but identification scores were low and test results were discrepant. However, when the biochemical test profile was placed in the computer database as a new organism, all strains were identified as the organism with high identification scores (0. 999968 to 0.999997) and no discrepant test results. By 16S rRNA sequence analysis the organism clustered most closely with, but was distinct from, citrobacter farmeri and citrobacter amalonaticus. Based on its unique biochemical profile and rRNA sequence, this organism is designated Enteric Group 137. Restriction endonuclease analysis and taxonomic antibiograms of strains causing the outbreak demonstrated a single clone of Enteric Group 137, and antibiotic susceptibility testing revealed the presence of extended-spectrum beta-lactamase (ESBL) resistance. Enteric Group 137 appears to be a new opportunistic pathogen that can serve as a source of ESBL resistance in the hospital.
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ranking = 69.249510872183
keywords = wound infection, wound
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4/26. citrobacter diversus endocarditis.

    citrobacter species are motile Gram-negative bacilli that cause disease in humans, such as urinary tract infection, pneumonia, superficial and deep wound infections, gastroenteritis, meningitis, bacteremia, and rarely endocarditis. In those cases of endocarditis, intravenous drug use has been associated with citrobacter species. Gram-negative organisms are present in less than 10% of cases of endocarditis in intravenous drug users. We present a case of tricuspid valve endocarditis in an intravenous drug user caused by citrobacter diversus alone.
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ranking = 69.249510872183
keywords = wound infection, wound
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5/26. Myonecrosis caused by edwardsiella tarda: a case report and case series of extraintestinal E. tarda infections.

    edwardsiella tarda is an unusual human pathogen. It is primarily associated with gastrointestinal disease, although recent reports of extraintestinal disease are broadening the current understanding of the clinical spectrum of E. tarda. A series of 11 cases of extraintestinal E. tarda infection is presented, including the first reported case of myonecrosis in an immunocompetent patient. Wound infections were the most common manifestation, and 3 of 5 patients with infected wounds had been exposed to a marine environment. One patient had bacteremia, and the remaining 5 patients developed abscesses that required surgical drainage. Four patients had E. tarda isolated in pure culture, including the patient with myonecrosis. Although it is often difficult to ascertain the contribution of E. tarda to infection when it is isolated as part of a mixed culture, this case series suggests that E. tarda is singularly capable of causing limb- and life-threatening infections.
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6/26. Postoperative morganella morganii endophthalmitis associated with subclinical urinary tract infection.

    We report a case of morganella morganii acute endophthalmitis following clear corneal phacoemulsification cataract surgery in which a coincident asymptomatic chronic urinary tract infection was detected postoperatively. morganella morganii is a gram-negative bacillus that inhabits the gastrointestinal tract and is part of the normal fecal flora. It is an opportunistic pathogen usually encountered in postoperative and nosocomial settings, causing urinary tract and wound infections. Chronic urinary tract infection may be a risk factor for postoperative endophthalmitis. A dipstick urinalysis before elective cataract surgery in elderly patients with a history of recurrent urinary tract infections may be considered.
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ranking = 69.249510872183
keywords = wound infection, wound
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7/26. Successful treatment of infected vascular prosthetic grafts in the groin using conservative therapy with povidone-iodine solution.

    Four cases of infected vascular prosthetic graft in the groin successfully treated with povidone-iodine solution using a conservative approach are described here. In all patients the same technique was used. After complete debridement, the prosthetic graft in the groin was completely exposed. The wound was cleansed with hydrogen peroxide and then dressed with gauze soaked in 1:10 sterile water-diluted povidone-iodine solution. The dressings were changed twice a day. The patients were supplemented by systemic therapy of an appropriate antibiotic. All patients were observed in the intensive care unit. In all patients this treatment method led to control of infection and healing of the wound. Thus, it was not necessary to remove the prosthetic graft and patients were spared a major surgical intervention. At follow-up, the prosthetic grafts remain patent without any signs of recurrence of infection.
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keywords = wound
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8/26. Bladder wall abscess following midurethral sling procedure.

    Midurethal sling procedures are gaining popularity as the treatment of choice for stress urinary incontinence. Complications that were described include bladder perforation, urinary retention, pelvic hematoma and suprapubic wound infection. Sling erosion and pelvic abscess are rare complications of midurethral slings. We report the first case of an abscess formed within the wall of the urinary bladder, 7 months following a midurethral sling procedure.
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ranking = 69.249510872183
keywords = wound infection, wound
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9/26. First case of septicemia due to a strain belonging to enteric group 58 (enterobacteriaceae) and its designation as Averyella dalhousiensis gen. nov., sp. nov., based on analysis of strains from 20 additional cases.

    When enteric group 58 was first described as a distinct new group of enterobacteriaceae in 1985, there were only five known human isolates: four from wounds and one from feces. In 1996, we investigated the first blood isolate of enteric group 58, a case of sepsis in a 33-year-old woman receiving total parenteral nutrition. Fifteen additional clinical isolates have since been identified at CDC, including several recognized from a collection of "unidentified" strains dating back to 1973. All strains were characterized with a standard set of 49 biochemical tests used for enterobacteriaceae, and the results were analyzed to determine phenotypic relatedness and best taxonomic fit. Antibiograms were determined as a taxonomic tool. Original identifications provided by submitting laboratories encompassed a wide variety of enterobacteriaceae, including 14 species in eight genera, the most common being Enterobacter spp., salmonella spp., Serratia spp., kluyvera spp., or escherichia spp. Enteric group 58 strains have been most frequently isolated from traumatic injuries, fractures, and wounds and rarely from feces. Defining its clinical significance and distinguishing infection from colonization requires further study, but our case report indicates that serious systemic infection can occur. The vernacular name enteric group 58 was used from 1985 to 2004. In this paper, we formally name it Averyella dalhousiensis gen. nov., sp. nov., on the basis of its unique phenotype and its unique 16S rRNA gene sequence. These data indicate that enteric group 58 is not closely related to any of the existing genera or species of enterobacteriaceae. The type strain is designated CDC 9501--97, and a phenotypic definition is given based on all 21 strains.
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keywords = wound
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10/26. Necrotizing myositis secondary to serratia marcescens in a renal allograft recipient.

    We describe a fatal case of spontaneous necrotizing myositis due to a highly resistant strain of serratia marcescens in a renal transplant recipient. Though staphylococcus aureus and clostridium are the usual agents which cause either pyomyositis or necrotizing myositis, gram-negative bacteria are a dangerous and rarely suspected possibility. Such an aggressive disease should be promptly recognized because immunosuppression in susceptible hosts makes conservative management unsuccessful. The prognosis for myositis in immunodepressed hosts is poor and wide excision of all the necrotic muscles, leaving the wound open, and intensive antibiotic therapy are required.
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keywords = wound
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