Cases reported "Staphylococcal Infections"

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1/22. Community-acquired methicillin-resistant staphylococcus aureus endocarditis with septic embolism of popliteal artery: a case report.

    A 20-year-old man presented with a 14-day course of fever. physical examination showed petechiae of the conjunctivae, Janeway lesions on both hands, a grade III/VI systolic murmur over the apex, pulseless dorsal pedal artery and posterior tibial artery of the right leg, and a pale right foot. Femoral arteriogram of the right leg revealed total occlusion of the popliteal artery with collateral circulation of the posterior tibial artery. Transthoracic echocardiogram showed trace mitral regurgitation. embolectomy of the right popliteal artery was done, and penicillin and gentamicin treatment was administered. However, postoperative fever developed intermittently. Transesophageal echocardiogram disclosed vegetation over the anterior leaflet of the mitral valve. methicillin-resistant staphylococcus aureus (MRSA) was isolated from all three cultures of blood drawn at admission and from the septic embolus during operation. He had neither evidence of underlying heart disease, nor history of intravenous drug abuse or hospitalization. Exploratory cardiotomy with removal of vegetation on the mitral valve was performed followed by a 4-week treatment with intravenous vancomycin. After discharge, he was well at 2-year follow-up.
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2/22. Percutaneous treatment of chronic MRSA osteomyelitis with a novel plant-derived antiseptic.

    BACKGROUND: Antibiotic-resistant bacteria such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE, are an increasing problem world-wide, causing intractable wound infections. Complex phytochemical extracts such as tea tree oil and eucalypt-derived formulations have been shown to have strong bactericidal activity against MRSA in vitro. Polytoxinol (PT) antimicrobial, is the trade name of a range of antimicrobial preparations in solution, ointment and cream form. methods: We report the first use of this drug, administered percutaneously, via calcium sulphate pellets (Osteoset,TM), into bone, to treat an intractable MRSA infection of the lower tibia in an adult male. RESULTS AND DISCUSSION: Over a three month period his symptoms resolved with a healing response on x-ray and with a reduced CRP.
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3/22. Successful reimplantation of total femoral prosthesis after deep infection.

    A 16-year-old boy developed a deep infection with methicillin-resistant staphylococcus aureus 6 months after total femoral replacement including knee and hip joints. The deep infection was eradicated by the use of debridement with continuous irrigation and removal of all prosthetic components followed by insertion of an antibiotic-impregnated cement spacer. Six weeks later, the total femoral prosthesis could be successfully reimplanted with both acetabular and tibial components. Two and half years later, the patient remained free of infection. debridement with continuous irrigation and an antibiotic-impregnated cement spacer can be a feasible technique for the treatment of deep infection after large prosthetic replacement. Furthermore, reimplantation should be performed after a short waiting period. Such treatment should be considered before deciding on amputation.
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4/22. Distraction osteogenesis for knee arthrodesis in infected tumor prostheses.

    Three patients had distraction osteogenesis as a salvage method for infected endoprostheses. At the first operation, the infected prosthesis was removed and stabilization was achieved with an external fixator to preserve limb length. An additional external fixator was applied later for distraction osteogenesis after ensuring that there was no infection. osteotomy was done at two sites on the femur, or tibia and femur, respectively, as a second operation. A third surgery was done at the docking site at the edge of the transported bone fragments. curettage, refreshing, and soft tissue release were done to enhance bone union. The healing index was 18.3 days/cm in Patient 1, 17.7 days/cm in Patient 2, and 33.0 days/cm in Patient 3. All patients walk without a cane. It has been shown that patients can obtain a long-lasting and weight-bearable leg with our method, because their viable bone establishes biomechanical stability. Loss of knee function, a longer treatment period, and pin site treatment are the weaknesses of our method. Our method is indicated for patients in whom systemic disease can be controlled well and who have longer life expectancy.
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5/22. Staphylococcal rib osteomyelitis in a pediatric patient.

    osteomyelitis in children commonly occurs in the long bones such as the femur, tibia, and humerus. It is rarely found in the ribs, occurring in less than 1% of children with osteomyelitis. Thirteen cases of rib osteomyelitis were reported in the literature, of which, 11 were caused by Staphylococcus aureus. Pediatric osteomyelitis often masquerades as skeletal neoplasia, as illustrated in the following case presentation. Here, the authors describe a case of pediatric staphylococcal rib osteomyelitis, review the published literature on similar cases, and describe its medical and surgical treatment.
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6/22. A case of graft infection 10 years after ascending aorta replacement.

    A 52-year-old man was admitted with anemia and slight fever, which he had for the last 2 months. He had undergone replacement of the ascending aorta for acute aortic dissection 10 years previously. echocardiography demonstrated a flailing thin structure in the anterior wall of the ascending aorta corresponding to the proximal portion of the prosthetic graft. This abnormal echocardiographic finding led us to repeat blood cultivation. We finally detected enterococcus facium and staphylococcus epidermidis in his blood sample. We diagnosed this as a graft infection and prepared for surgical re-replacement of the infected graft. While he was waiting for the operation, an infectious aneurysm of a tibialis posterior artery ruptured and an emergency operation was done. Replacement of the infected ascending aorta graft was done thereafter. In surgery, 2-cm-long vegetation was found. It stuck to the graft wall near the former hole used for air removal in the first surgery. The patient recovered fully and left our hospital after 3 months of postoperative antibiotics therapy. This rare case of aortic graft infection long after the original replacement surgery suggests the importance of thorough echocardiographic investigation of prosthetic graft infection as a possible cause of fever of unknown origin.
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7/22. Treatment of infected segmental defect of long bone with vascularized bone transfer.

    Experience with infected pseudarthrosis with segmental osseous defect, treated by debridement and microvascular bone transfer, is reported. Fourteen patients form the basis for the study, including 12 males and two females. Patient age at the time of operation averaged 35.1 years. Follow-up averaged 52 months. The affected site included tibia (10), femur (2), and ulna (2). A total of 15 vascularized bone graft transfers were carried out for the 14 patients, with the donor bone fibula (8) and ilium (7). Bony union was ultimately obtained in all patients. In 11 patients, primary union was obtained at both ends of the transferred bone segment. In the remaining three patients, a secondary procedure, consisting of onlay nonvascularized bone autografting at one end of the vascularized transferred bone segment, was required to obtain union. Recurrent infection following union occurred in one patient. One of the two patients with active osteomyelitis at the time of vascularized bone transfer had complications from recurrent sepsis, leading to the authors' caveat that vascularized bone transfer should be deferred until such time as sepsis is inactive. Criteria used in this series for determining inactive sepsis (absence of sinus tracts, negative bacterial cultures, negative c-reactive protein, and a sedimentation rate of less than 15 mm per hour) seem appropriate. The study suggests that vascularized bone transfer is a useful procedure for the treatment of infected segmental osseous defects of long bones, of more than 3 cm extent and one month or more after inactive sepsis.
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8/22. Epiphyseometaphyseal cupping of the distal femur with knee-flexion contracture.

    An 11-year-old child with a history of receiving megadoses of vitamin a as an infant, and a 4-year-old child with a history of fulminant staphylococcal septicemia with multiple joint involvement presented with recalcitrant knee-flexion contractures. Roentgenography revealed epiphyseometaphyseal cupping (ie, epiphyseal invagination) of the distal femur. osteotomy resulted in only temporary correction. Our experience suggests that in the skeletally immature child, skin traction, physical therapy, splinting, and, in some instances, two-pin tibial traction should be the treatments of choice.
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9/22. Infected uncemented hip arthroplasty. Preserving the femoral stem with a two-stage revision procedure.

    Revision of an infected uncemented hip arthroplasty can be significantly complicated by the presence of extensive bony ingrowth. Although removal of the prosthesis is desirable, technical difficulties in extracting a well anchored prosthesis can be extreme. Femoral windowing or splitting may be necessary. In these cases, treatment alternatives that avoid destruction of the femoral cortex are desirable. A 47-year-old man presented with a deep infection of a virtually fully coated porous implant two years postoperatively. Radiographs revealed extensive bony ingrowth and an arthrogram revealed no dye tracking down the femoral canal. The infecting organism was Staphylococcus epidermis. In order to avoid the possible complications of extraction of this fully coated stem, treatment was carried out initially with removal of the bipolar head, joint debridement, and placement of antibiotic impregnated beads. After seven weeks of intravenous antibiotic therapy with the patient in tibial pin traction, a revision was undertaken and the acetabulum was revised with a threaded uncemented acetabular component. The patient recovered and at 18 month follow-up is without evidence of infection and back to full function. Revision with a two-stage femoral stem preserving procedure is presented as an alternative in the management of infected uncemented hip arthroplasty.
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10/22. indium-111-labeled leukocyte scintigraphy: diagnosis of subperiosteal abscesses complicating osteomyelitis in a child.

    Preoperative 111In-labeled leukocyte scintigraphy demonstrated extensive subperiosteal abscesses complicating acute bilateral tibial osteomyelitis in a child. Plain radiographs showed only marked soft-tissue swelling; three-phase bone scintigraphy depicted both "hot" and "cold" areas consistent with acute osteomyelitis.
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