Cases reported "Surgical Wound Infection"

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1/142. Streptococcal keratitis after myopic laser in situ keratomileusis.

    A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'Streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.
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2/142. Bacterial keratitis following laser in situ keratomileusis for hyperopia.

    A 42-year-old Bahraini man had uneventful laser in situ keratomileusis for hyperopia (OD: 3.00 0.75 x 155 degrees; OS: 2.00 0.50 x 155 degrees). Three weeks later, he presented with localized keratitis in his right eye, with localized keratitis at the flap margin with stromal edema. Uncorrected visual acuity was 20/80 OD with no improvement with pinhole, and was 20/20 OS. Corneal smear culture showed a positive growth of staphylococcus aureus. The patient was immediately treated with subconjunctival gentamicin and intensive topical ofloxacin 0.3% with systemic cephalosporin. The patient recovered from keratitis within 2 weeks and his uncorrected visual acuity OD improved to 20/20. keratitis following LASIK should be treated promptly so that it does not lead to permanent reduction in visual acuity.
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3/142. Chronic sternal wound infection and endocarditis with coxiella burnetii.

    Chronic q fever is most commonly associated with culture-negative endocarditis and less frequently with infection of vascular grafts, infection of aneurysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnormalities. We report a case of chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia in which q fever endocarditis was subsequently diagnosed. polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii dna, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multisystem inflammatory dysfunction, aberrations of the immune system, and persistent wound infections.
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4/142. mediastinitis due to Gordona sputi after CABG.

    Genus Gordona is included in mycolic acid containing bacteria. This genus infection is very rare and occurs classically in immuno-compromised patients. We report a patient who developed mediastinitis due to Gordona sputi after coronary artery bypass grafting (CABG) using left internal mammary artery. Immunocompromised factors were not noticed in this case but postoperative bleeding, the most important risk factor of mediastinitis, was found in his course. The treatment was antibiotic therapy, surgical soft tissue debridement and open irrigation with dilute povidone-iodine solution. However, infectious reaction continued and Gordona sputi repeated cultured from wound. Next procedure, debridement of sternal bone and omental transfer, was performed and skin was closed primarily. Inflammatory reaction was attenuated and the wound was healed Broad debridement and omental transfer were very effective for mediastinitis due to Gordona sputi after CABG.
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5/142. Delayed infections following full-face CO2 laser resurfacing and occlusive dressing use.

    BACKGROUND: carbon dioxide (CO2) laser resurfacing has become an increasingly popular procedure for the treatment of facial rhytides and solar damage. Yet despite ongoing advancements in laser technology, CO2 laser resurfacing is still a risk-laden procedure that may lead to complications such as infection. occlusive dressings increase the healing rate and decrease pain intensity in patients who receive full face laser resurfacing. It has been said that the use of occlusive dressings in postresurfacing patients may increase the risk of infection, which typically presents 2-10 days after the procedure. OBJECTIVE: The purpose of this article is to report the incidence of infection following full-face CO2 laser resurfacing of 354 patients who were treated with occlusive dressings. In addition, factors which may have contributed to the delayed onset in three of the four infections are discussed. methods: Three hundred fifty-four patients received full-face CO2 laser resurfacing. Either a continuous wave CO2 laser with a computer-generated scanner (396 microseconds dwell time, 18 W) or a pulsed CO2 laser (500 mJ pulse energy, 90 microseconds pulse duration) were used in all cases of resurfacing. Postoperatively all patients were treated with occlusive dressings and empiric oral cephalexin. Postoperatively patients were monitored at weekly intervals during the first month and then at 3 and 6 months. RESULTS: Of the 354 patients who received full-face laser resurfacing, there were 4 cases of culture-proven infection, which translates to an infection rate of 1.13%. Three of the four infections developed 3-5 weeks after the procedure. CONCLUSION: This study reports an infection rate of 1.13% following full-face CO2 laser resurfacing and occlusive dressing use in 354 patients. Because infection may develop many weeks after the procedure, patients should be educated to maintain proper wound care hygiene and to avoid "double dipping" of wound care products until wounds are completely healed.
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6/142. Infectious keratitis after photorefractive keratectomy in a comanaged setting.

    A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.
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7/142. Postoperative mycobacterium avium osteomyelitis confirmed by polymerase chain reaction.

    An 18-year-old male with Escobar syndrome developed mycobacterium avium osteomyelitis after corrective osteotomy. After three surgical interventions the infection reappeared a fourth time. Repeated attempts at microbiological diagnosis of the granulomatous lesions by microscopy and culture for conventional bacteria and Mycobacteria did not reveal any organism. The diagnosis of mycobacterium avium finally was achieved by polymerase chain reaction. Extensive immunological work-up did not reveal signs of immunodeficiency. The patient was treated successfully by a combined surgical and chemotherapeutic approach consisting of clarithromycin, ethambutol and ciprofloxacin. CONCLUSION: polymerase chain reaction may be especially useful for clinical situations with a low bacterial load, especially for fastidious and slow growing pathogens like Mycobacteria. In our patient a combination of surgical therapy with a triple regimen containing clarithromycin proved successful for treatment of a localised infection with M. avium in a supposedly immunocompetent host.
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8/142. Persistent wound infection after herniotomy associated with small-colony variants of staphylococcus aureus.

    A small-colony variant (SCV) of staphylococcus aureus was cultured from a patient with a persistent wound infection (abscess and fistula) 13 months after herniotomy. The strain was nonhemolytic, nonpigmented and grew only anaerobically on Schaedler agar. As it was coagulase-negative, it was initially misidentified as a coagulase-negative Staphylococcus. In further analysis, however, the microorganism was shown to be an auxotroph that reverted to normal growth and morphology in the presence of menadione and hemin (Schaedler agar) and could be identified as a SCV of staphylococcus aureus. Surgery and antibiotic treatment of the patient with flucloxacillin and rifampicin for 4 weeks resulted in healing of the chronic wound infection.
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9/142. Pneumococcal keratitis after laser in situ keratomileusis.

    A 20-year-old man developed keratitis in his right eye 2 days after laser in situ keratomileusis (LASIK). The patient had rubbed the eye with unclean fingers the night before the onset of symptoms. Examination showed an inferior corneal ulcer with dense infiltration at the junction of the lamellar flap and the surrounding cornea associated with a hypopyon. streptococcus pneumoniae was isolated on culture. The ulcer resolved with combination therapy of cephazolin 5% and tobramycin 1.3% eyedrops. patients having LASIK should be instructed that inadequate patient hygiene may predispose to bacterial keratitis.
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10/142. Fungal keratitis after laser in situ keratomileusis.

    A 22-year-old woman presented with pain, redness, watering, and decrease in vision in her left eye 15 days after laser in situ keratomileusis for myopia. Slitlamp examination showed a central full-thickness infiltrate with hyphate edges. Microscopic examination of corneal scrapings from the edge and underneath the flap showed fungal filaments, and the growth on culture media was identified as scedosporium apiospermum.
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