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Two previously healthy adults, a man aged 69 and a woman aged 51 years, presented with spondylitis caused by Streptococcus agalactiae. One patient had fever and acute pain in the neck, the other progressive pain in the lower back. From cultures of blood and bone respectively. S. agalactiae was isolated. Both patients recovered after treatment with benzylpenicillin. S. agalactiae (group B streptococcus) is a wellknown cause of invasive infections in neonates and pregnant adults. Infections in nonpregnant adults are increasingly reported. Chronic conditions such as diabetes mellitus are strongly associated with disease caused by S. agalactiae.
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PMID:[Spondylodiscitis caused by Streptococcus agalactiae]. 919 May 11

Total knee arthroplasties are at risk for hematogenous seeding secondary to procedures that create a transient bacteremia. To define the risk of infection associated with dental surgery, a retrospective review of the records of 3490 patients treated with total knee arthroplasty by the authors between 1982 and 1993 was performed. Sixty-two total knee arthroplasties with late infections (greater than 6 months after their procedure) were identified, and of these, seven infections were associated strongly with a dental procedure temporally and bacteriologically. These seven cases represented 11% of the identified infections or 0.2% of the total knee arthroplasty procedures performed during this period. In addition, among 12 patients referred for infected total knee arthroplasties from outside institutions, two infections were associated with a dental procedure. Five of the nine (56%) patients had systemic risk factors that predisposed them to infection, including diabetes and rheumatoid arthritis. All dental procedures were extensive in nature (average, 115 minutes; range, 75-205 minutes). Eight of the patients received no antibiotic prophylaxis. One patient had only one preoperative dose. Infections associated with dental procedures may be more common than previously suspected. Eight of these patients had no prophylactic antibiotics, and one had inadequate coverage. The authors think that patients with a total knee arthroplasty who have systemic disease that compromises host defense mechanisms against infections and who undergo extensive dental procedures should receive prophylactic antibiotics. A first generation cephalosporin, given 1 hour preoperatively and 8 hours postoperatively would provide the best prophylaxis against the organisms identified in this study.
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PMID:Total knee arthroplasty infections associated with dental procedures. 975 87

Xenotransplantation is a potential solution to the current donor shortage for allotransplantation. Likewise it is being investigated for a number of other disease states such as Parkinson's disease, diabetes, and acquired immunodeficiency disease. Infections are a concern with the use of any biologic agent and as such have proved to be a substantial cause of morbidity and mortality after allotransplantation. Similarly, infections will likely cause disease after xenotransplantation. Public debate on the ethics of whether the field of xenotransplantation should move forward has focused on the concern of novel infections, xenozoonoses. Accordingly, the role of animal microbes must be critically examined. This article reviews mechanisms for xenogeneic infections and details what is known and what still needs to be learned as the field of xenotransplantation progresses. Emphasis is placed on microbial agents of baboons and swine, as they are currently the most common species considered as donor sources for xenotransplantation.
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PMID:Infectious concerns of cross-species transplantation: xenozoonoses. 936 13

Infective endocarditis caused by beta-hemolytic streptococci is infrequently seen. Members of the Infectious Diseases Society of America's Emerging Infections Network (EIN) were polled for cases of beta-hemolytic streptococcal endocarditis that were seen between 1 January 1994 and 31 December 1996. Thirty-one cases were submitted by 22 members. The patients' ages ranged from 4 months to 79 years, and 18 (58.1%) were males. Prosthetic valve infection occurred in six cases and intravenous drug abuse was noted in only one case. Diabetes mellitus was noted in 10 patients (32.3%). Group B beta-hemolytic streptococci accounted for over two-thirds of isolates (21 [67.7%] of 31). Twenty-five patients (80.7%) developed complications of infective endocarditis, and 15 (48.4%) underwent surgical intervention with valvular revision or excision. Sixty-one percent (19 of 31) received aqueous crystalline penicillin G either as monotherapy or in combination with gentamicin sulfate. In contrast to previously published data, the mortality rate (12.9%) among patients in this survey was remarkably low. There was no infection relapse documented in 16 of the remaining 27 patients for whom posttreatment follow-up information was available.
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PMID:Infective endocarditis caused by beta-hemolytic streptococci. The Infectious Diseases Society of America's Emerging Infections Network. 945 11

Infections are an increasing problem in the elderly population, because of the often atypical presentation and the more frequent occurrence of complications, which lead to increased morbidity and mortality. The increased prevalence of infections in the elderly is due to a number of factors: increased exposure to micro-organisms (especially in nursing homes); degeneration of various organs (atherosclerosis, pulmonary emphysema, diverticulosis, prolapse); decreased immune response; concomitant diseases (e.g. diabetes mellitus) and (or) use of medication. There is often a delay in the diagnosis because the presentation of infection in the elderly is frequently atypical and symptoms are attributed to old age, rather than to infection. Treatment may be hampered by increased resistance of micro-organisms, interaction with other drugs and toxicity problems.
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PMID:[Infections in elderly patients]. 955 Jul 96

A retrospective survey of 850 spinal procedures was conducted to determine risk factors for postoperative spinal infection. Some 574 posterior and 276 anterior procedures were evaluated. Infections were classed as early (within 19 weeks postoperatively) and late (> or = 20 weeks postoperatively), as well as deep and superficial infections. Previously postulated risk factors (i.e., diabetes, corticosteroid therapy, previous spinal surgery, obesity, chronic infection, and smoking) were investigated. Furthermore, it was hypothesized that three additional factors: extended preoperative hospitalization, prolonged operation duration, and high blood loss were risk factors not previously considered. A postoperative infection was evident in 22 of 850 procedures (19 early/three late infections, four superficial/18 deep infections). Most infections (n = 21) occurred with posterior instrumentation. Previously described factors were proven as risk factors. Extended preoperative hospitalization (p < 0.04), high blood loss (p < 0.01), and prolonged operation time (p < 0.001) were additionally determined as risk factors. The results suggest that routine prophylactic antibiotics might be unnecessary in anterior surgery, whereas extended prophylactics should be considered in posterior instrumentation, especially when risk factors are apparent.
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PMID:Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. 958 68

The treatment results is a series of twenty-six patients running a very serious course of soft-tissue infections are analyzed. Of the total number ten have diabetes mellitus. The sepsis severity score is 23 average according to the APACHE II rating system. Operative management is undertaken without any delay. It is preceded by comprehensive correction of the metabolic disorders present and antibiotic treatment, initially substantiated by presumable microbial causing agents. A total of 62 operations are done. In 36 per cent of cases being examined, the microbiological study contributes to a proper orientation of the antibiotic therapy performed. Bacteremia is documented in three instances. Total mortality rate amounts to 32 per cent (8 patients). Infections running a serious clinical course may be caused by one or more microorganisms, but in either case the lethality is noteworthy. Active surgical management may prove effective provided it is initiated in the most opportune time. It is only part of the complex therapeutic approach to sepsis.
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PMID:[The treatment problems of soft-tissue infections]. 973 81

The introduction of tacrolimus has shown decreased rates of acute and steroid-resistant rejection after liver transplantation (LTx). The aim of the present study is to examine the long-term efficacy and safety of tacrolimus in primary liver transplant recipients. The first 121 consecutive adults (aged >16 years) who underwent primary LTx at a single center from August 1989 to February 1990 were followed up until August 1997. The mean follow-up was 93.2 +/- 1.2 months (range, 90.5 to 96.5 months). Patient survival, graft survival, rate of rejection, and adverse events were examined. The actual 7-year patient survival rate was 67.8%, and the graft survival rate was 63.6%. Infections, recurrence of disease, de novo malignancies, and cardiovascular events constituted the main causes of graft loss and death in the long term. Graft loss related to acute or chronic rejection was rare. The rate of acute rejection beyond 2 years was approximately 3% per year, and most rejections were steroid responsive. Approximately 70% of the patients received only tacrolimus after 1 year. Four patients developed end-stage renal disease, and 2 patients underwent kidney transplantation. Hyperkalemia and hypertension were observed in one third of the patients. New-onset insulin-dependent diabetes mellitus was observed in 9% and 13% of the patients at the 1-year and 7-year follow-up, respectively. Seven patients developed de novo malignancies, including two skin malignancies. Six patients developed posttransplantation lymphoproliferative disorder during the entire follow-up period. Actual patient and graft survival at 7 years was excellent, and few adverse events developed after the first year. Graft loss from acute or chronic rejection was rare under tacrolimus, and approximately 70% of the patients were steroid free on tacrolimus monotherapy after the first year after LTx.
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PMID:Primary adult liver transplantation under tacrolimus: more than 90 months actual follow-up survival and adverse events. 1007 54

We revised retrospectively 30 cases of Spontaneous Infectious Spondylodiskitis (SIS) in adults, diagnosed between 1986 and 1997. The mean age of the patients was 68.8 years; 56.7% were males. The identifiable causes were infectious endocarditis 13 (43.3%); tuberculosis 7 (23.3%); urinary tract infection 4 (13.3%); bacteremia with focus 2 (6.7%) and without focus 2 (6.7%). The cause was not identified in other 2 cases (6.7%). Infections were due to pyogenic bacteriae in 19 (63.3%); tuberculosis 6 (20%) and unknown 5 (16.7%). All patients had localized pain, 70% fever, 36.7% irradiated pain and 23.3% paraparesis. Fever was more frequent in patients with pyogenic etiology than in those with tuberculous SIS (p = 0.004). Blood cultures were positive in 70.4%. Percutaneous aspiration of the disc was performed in 13 patients; cultures were positive in 7. Causal germs were Streptococcus spp. 33.3%; Mycobacterium tuberculosis 20%; Staphylococcus spp. 16.6%; Escherichia coli 6.6%; Pseudomonas aeruginosa 6.6%. There was no bacteriological recovery in 5 (16.7%). Localization was lumbar in 18 (60%), dorsal in 8 (26.6%) and cervical in 4 (13.3%). X-ray of the spine was positive in 63.3% of the cases. Technetium scan in 90.5%, CT in 85.7% and MRI in 100% of cases in which it was carried out. All patients received antibiotic treatment with a median duration of 6 weeks for pyogenic SIS and one year for tuberculous SIS. Eighty three percent required immobilizing brace and 10% surgery for stabilization. Thirty six percent of patients presented complications, most of them related to the causal disease. There was a statistically significant association between mortality and diabetes.
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PMID:[Spontaneous infectious spondylodiscitis in adults. Analysis of 30 cases]. 1041 91

Diabetic foot occurs due to the loss of protective sense and circulation disorder and a marked proneness to infections. Mechanical stress of bone growths frequently leads to ulcerations. The prevention and timely treatment of diabetic foot requires the participation of both patients and all health care levels. This consensus is given for the purpose of procedure standardization. Education is the basis of prevention and should be carried out with every patient suffering from diabetes mellitus and those with a sensory defect in particular. Appropriate footwear significantly contributes to prevention and treatment of ulcers. As regards the treatment, the necessity of surgical approach with a long term and often manifold antibiotic therapy should be pointed out. Infections are usually mixed. The deeper the ulceration, the more likely the infection with anaerobes and Gram-negative bacteria occurs in addition to Gram-positive ones which are normally present in surface lesions. Strict metabolic control is a precondition for successful treatment. In conclusion, diabetic foot is a major health problem which requires multidisciplinary approach with permanent patient education as its essential part, and a specific cooperation of all levels and different health care specialties.
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PMID:[The diabetic foot. The Croatian model--national consensus (clinical recommendations for diagnosis, prevention and therapy)]. 1049 51


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