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1/10. Aeromonas wound infection in burns.

    Infection of burn patients with the Aeromonas organism is an uncommon event. This paper documents four cases of aeromonas hydrophila and one case involving both A. hydrophila and A. caviae occurring in burn patients between 1990 and 1998 at the Royal Brisbane Hospital burns unit. The organism was isolated from either skin swabs, tissue samples, blood cultures or cultured lines. In all patients there was a history of immersion in water immediately post burn. There is one case of invasion and destruction of deeper tissues and one fatality. Appropriate management requires a high index of suspicion if a history of immersion in untreated water post burn is given and the treatment involves aggressive excision and antibiotic therapy.
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2/10. Transcatheter embolization of mycotic aneurysm of the subclavian artery with metallic coils.

    Mycotic aneurysms of the subclavian artery are rare. This report describes an experience of 2 rare cases in which transcatheter embolization with metallic coils was performed for the management of these lesions alternative to surgery. Two patients who had been treated with chemotherapy for malignant neoplasms were diagnosed as having mycotic aneurysms of the left subclavian artery. The causes of these lesions were presumed to be the invasion of the arterial wall by the pulmonary abscess in case 1, and wound infection after placement of the reservoir for intraarterial chemotherapy in case 2. In both cases, proximal and distal sites of the aneurysm were embolized with metallic coils. In case 1, the vertebral artery was also embolized with Guglielmi detachable coils to avoid retrograde blood flow. Both aneurysms were completely occluded by a single embolization. In case 1, although weakness and paresthesia of the left hand remained, lethal hemoptysis due to aneurysmal fistulization to the lung parenchyma ceased. In case 2, no neurological deficit except for mild paresthesia in the left thumb had been observed. Both patients died of primary disease 10 and 5 months after the procedure. Transcatheter embolization is technically feasible and effective enough to treat the mycotic aneurysm of the subclavian artery even in the situation in which the surgical option seems to be difficult or risky.
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3/10. aeromonas hydrophila wound infection in elective surgery.

    patients with diabetes mellitus are subject to wound infection with unusual pathogens. A patient who had colonic surgery developed aeromonas hydrophila wound infection, which mainly results from contamination by water or soil.
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4/10. Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case report.

    A 3-year-old girl with 52% TBSA scalds, mostly partial thickness, was treated topically with 5% mafenide acetate solution and 1% silver sulfadiazine cream. All blood cultures and wound swabs were negative for the first 5 days. On day 6 gram-negative bacteria and yeast forms were isolated from her wounds. High fever and leukocytosis were present and the child was treated with intravenous ampicillin and gentamicin according to sensitivity bacteriogram. The bacteria were identified as pseudomonas aeruginosa and the yeast was candida tropicalis. On day 7, escherichia coli was identified in blood cultures and intravenous cefixime was added. amphotericin b was added on day 9 when blood cultures grew candida tropicalis and burkholderia cepacia. On day 13 dark pigmentation foci developed on some areas of partial-thickness burns in the back, resembling invasive wound infection. White blood cell count was 14,300 cells/mm3, and her body temperature reached 39.7 degrees C. Cultures from the pigmented areas were negative, and biopsies revealed deposits of silver. Most of the areas healed uneventfully, and only about 8% TBSA needed grafting, including some of the pigmented areas. No residual pigmentation remained on discharge.
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keywords = wound infection
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5/10. A rare cause of wound infection: shewanella putrefaciens.

    shewanella putrefaciens has a wide geographical distribution, including all forms of sea water, fresh water, fish and soil. In humans, it is an unusual pathogen of wound infections. In this report, a wound infection was presented in a previously healthy man.
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6/10. Eikinella corrodens wound infection in a diabetic foot: a brief report.

    Eikinella corrodens normally forms part of the flora of the oral cavity and mucous membranes of the respiratory tract. It is usually associated with dental, head and neck infections (Cohen, Powderly, 2004, Infectious Diseases) and is considered to be an unusual cause of orthopaedic infections. We recently treated a diabetic patient with E. corrodens osteomyelitis of the fifth metatarsophalangeal joint, a phenomenon which has been reported in only three cases previously (Konugres et al., 1987, E. corrodens as a cause of osteomyelitis in the feet of the diabetic patients. Report of three cases). We recommend including E. corrodens in the spectrum of causative pathogens in diabetic foot infections.
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7/10. Fatal capnocytophaga infection associated with splenectomy.

    A case of fatal sepsis due to capnocytophaga species is described. Capnatophaga canimorsus and C. cynodegmi can cause localized wound infections and/or systemic infections in people who have been bitten, licked, scratched, or merely exposed to cats or dogs, especially splenectomized individuals. A thorough social, medical, and surgical history, the clinical presentation, and cultures are important in making the diagnosis of capnocytophaga infections. It is important that the forensic pathologist be aware of this zoonotic disease.
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8/10. Clinical implications of multi-drug resistance in the intensive care unit.

    A prospective in vitro survey of Gram-negative isolates obtained from patients hospitalized in intensive care units in 10 boston teaching hospitals was undertaken to document current susceptibility patterns and analyze patterns of cross-resistance. One thousand and five isolates were obtained, 18% were pseudomonas, 18% escherichia coli, 13% klebsiella, and 22% were in the enterobacter, citrobacter, serratia group. Cross-resistance among beta-lactams and beta-lactamase inhibitors was common for species with a potential to produce the type I inducible beta-lactamase (p less than 0.01). In contrast, resistance to imipenem was not associated with cross-resistance. ciprofloxacin and netilmicin also remained active. Clinical observations of the development of cross-resistance to the beta-lactams in enterobacter and citrobacter infections in four patients (two bacteremias and two wound infections) seen in one institution confirm these in vitro findings. Unanswered questions remain regarding the frequency of beta-lactam cross-resistance, the most likely sites of occurrence and the overall clinical significance. Clinicians should be aware of the potential selection of type-I beta-lactamase hyperproducers by the use of second or third generation cephalosporins or related beta-lactam agents.
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keywords = wound infection
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9/10. aeromonas hydrophila infections of skin and soft tissue: report of 11 cases and review.

    We report the clinical and microbiological characteristics of 11 cases of aeromonas hydrophila infection of skin and soft tissue, and we review the English-language literature on such infections. Of our 11 patients, seven (64%) presented to the hospital between the months of May and September (inclusive). Three patients (27%) had an underlying systemic illness, and two (18%) had nosocomially acquired infection. The nine patients with community-acquired infection had all experienced antecedent trauma, and seven (78%) of these nine reported recent exposure to freshwater. All patients had clinical evidence of soft-tissue inflammation, and nine (82%) had fever. Four wounds were characterized by a foul odor. The infection was polymicrobial in nine cases (82%). Treatment included the administration of antibiotics in nine instances, but empirical antimicrobial therapy provided coverage against Aeromonas in only two cases. Ten patients required surgical management of their wounds. Posttraumatic wound infections with a history of freshwater exposure should alert the clinician to the possible presence of A. hydrophila. Prompt surgical evaluation of wounds in combination with appropriate antibiotic therapy is recommended for the management of these infections.
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keywords = wound infection
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10/10. skin and soft-tissue manifestations of shewanella putrefaciens infection.

    shewanella putrefaciens, a saprophytic gram-negative rod, is infrequently recovered from clinical specimens. Although a number of clinical syndromes have been attributed to S. putrefaciens, the pathogenic role of this agent remains largely undefined. We report 16 cases of S. putrefaciens infection that occurred at the veterans General Hospital-Kaohsiung in taiwan between 1990 and 1995. S. putrefaciens infection was associated with a wide clinical spectrum including bacteremia/septicemia, skin and soft-tissue infection, biliary tract infection, peritonitis, and empyema. Five of our patients had skin and soft-tissue manifestations, including fulminant periorbitofacial cellulitis, dacryocystitis, perineal abscess, finger abscess, and postcholecystectomy wound infection. These clinical features deviated from the chronic ulcers or infected burns of the lower extremities that have been described in previous reports. Seven (44%) of our 16 patients had bacteremia/septicemia, and all seven had underlying hepatobiliary diseases. S. putrefaciens was isolated in mixed cultures of specimens from 14 patients; escherichia coli was the most common coisolate. Hepatobiliary diseases and malignancy were the major predisposing factors for S. putrefaciens infection of the biliary tract and S. putrefaciens bacteremia/septicemia.
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keywords = wound infection
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