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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 70-year-old man was seen in a hospital consultation for evaluation of cellulitis of the left arm. The patient had multiple medical problems, including advanced liver disease due to alcohol, diabetes mellitus, congestive heart failure, atrial fibrillation, chronic renal in sufficiency, and hypopituitarism requiring steroid replacement. Most recently, he was admitted to the intensive care unit, where he required intubation and mechanical ventilation support following respiratory failure secondary to pneumonia. At that time, an attempt was also made to place an arterial line in the left radial artery. The patient had multiple areas of ecchymosis on both arms. A large bulla was found on the lateral aspect of the left wrist several days after the attempted arterial line placement. Subsequently, the lesion drained serosanguineous fluid, and, during the next 2 days, it ulcerated with necrosis extending around the wrist and to the elbow. He was started on ampicillin/sulbactam and clindamycin for presumed necrotizing fasciitis. The surgical service performed a very limited debridement,which was partially limited by his coagulopathy from liver disease. The initial tissue culture was positive only for Enterococcus faecium. At the time of the consultation, his temperature was 95' F (35 degrees C), pulse 82 bpm, respirations 16 BPM, and blood pressure 101/56 mmHg. He was awake but not oriented or responsive. His cardiopulmonary exam was unremarkable. Abdominal exam disclosed ascites. His extremities were all grossly edematous with multiple ecchymoses. His left forearm had a circumferential area of ecchymosis and necrosis with macerated margins, sparing only the lateral ulnar epicondyle, and involving deeper structures of subcutaneous fat and muscle(Figures 1-2 showing evolution of the lesion in a period of 1 week). Small tissue clippings were taken from the edge of the lesion and placed on culture plates. By the next morning, the patient's tissue culture grew a mold, later identified as Rhizopus. Amphotericin B was initiated. Surgical intervention (wide debridement with potential conversion to amputation of the left arm) was considered to offer little benefit in view of the patient's multiple and severe comorbidities and his poor prognosis. Amphotericin B was then stopped; the patient died within a week from his multiple medical complications. The family refused an autopsy.
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PMID:Cutaneous zygomycosis following attempted radial artery cannulation. 1553 83

We report the case of a 73-year-old female patient with diabetic nephropathy and cholelithiasis. She was admitted to our hospital with right upper abdominal pain, nausea, and vomiting. The patient had visited an outpatient clinic with the same complaints 2 days earlier, and had been prescribed antibiotics empirically (two doses ofloxacin orally). Blood cultures taken before the start of antibiotic treatment in our hospital were negative. The patient was treated with parenteral ampicillin/sulbactam + ciprofloxacin empirically. The empiric antibiotic treatment was discontinued after 7 days. Elective cholecystectomy was performed after her general condition improved. An aerobic chocolate agar culture of the cholecystectomy material yielded Haemophilus influenzae type b. On postoperative day 3 the patient developed fever again. The fluids collected after cholecystectomy were evaluated microbiologically. H. influenzae type b was isolated from the samples and blood cultures. The patient was diagnosed with H. influenzae cholecystitis, and recovered after 10-day treatment with ampicillin/sulbactam + ciprofloxacin. The findings are discussed together with references for differential diagnosis. H. influenzae cholecystitis due to cholelithiasis, although rare, should be considered in elderly patients with a history of chronic diseases such as diabetes mellitus or nephropathy.
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PMID:Biliary infection and bacteremia caused by beta-lactamase-positive, ampicillin-resistant Haemophilus influenzae in a diabetic patient. 1572 89

During a 53-month period (March 1994 to August 1998), 48 Corynebacterium striatum isolates recovered from clinical specimens were characterized. The organisms were identified by both phenotypic characteristics and 16S rRNA gene sequence analysis. Thirty-six (75%) were isolated from sputum/bronchial aspirates, 10 (21%) from wound exudates/pus, 1 (2%) from vaginal discharge, and 1 (2%) from an otorrheic specimen. All 48 patients had been hospitalized for treatment of an underlying disease and had received antibiotics previously. The C. striatum isolates were considered pathogenic based on their abundance within polymorphonuclear neutrophils and their dominant growth in culture. Sensitivities of isolates to 11 antibiotics were determined by broth microdilution. MIC90 values of the isolates were 1 microg/mL for vancomycin, 16 microg/mL for penicillin and ampicillin, 32 microg/mL for minocycline, and > or = 32 microg/mL for cephalosporins, imipenem, ofloxacin, and macrolides. Restriction fragment-length polymorphism analysis with pulsed-field gel electrophoresis was used to determine the clonal identity. The pulse-field gel electrophoresis profiles revealed 14 distinct patterns with 20 subtypes. The isolates for the nosocomial outbreaks of C. striatum included 3 types (A, D, and E) with 4 subtypes (A1, A2, D2, and E). All 4 genotypes had broad-spectrum resistance to antimicrobial agents. Furthermore, type E strain isolated from 3 patients in the same ward was sensitive only to vancomycin. We conclude that C. striatum should be considered an emerging multidrug-resistant nosocomial pathogen in patients hospitalized for a prolonged period and/or in immunocompromised patients with such underlying conditions as cerebrovascular disease, pulmonary disease, diabetes, or malignancy.
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PMID:Emergence of multidrug-resistant Corynebacterium striatum as a nosocomial pathogen in long-term hospitalized patients with underlying diseases. 1640 81

Listeria monocytogenes usually causes meningitis or bacteremia, often in immunocompromised adults, pregnant women, or infants. We report a case of septic arthritis caused by L. monocytogenes in a patient with seronegative rheumatoid arthritis (RA) whose hip replacement was infected. She subsequently died, probably secondary to an adult respiratory distress syndrome, a rare complication of listerial infection. We also reviewed all 18 previously reported cases of septic arthritis caused by L. monocytogenes. The frequency of underlying RA, diabetes, neoplastic disease, and immunosuppressive therapy is prominent, as is the concurrent presence of a previous knee or hip replacement. Thus, the simultaneous presence of immune suppression and certain medical disorders or their treatment and a prosthetic joint should alert the clinician to the possibility that L. monocytogenes is the offending microbial agent. In contrast, in immunocompetent persons the usual Gram-positive cocci such as staphylococci, streptococci, or even pneumococci predominate. Although the outcome of appropriate treatment with penicillin or ampicillin alone (or with an aminoglycoside or trimethoprim/sulfamethoxazole in penicillin-allergic individuals) is usually favorable, complicating medical disorders can lead to death. Cephalosporins are rarely effective antimicrobial agents in patients with listeriosis.
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PMID:Is Listeria monocytogenes an important pathogen for prosthetic joints? 1703 86

An 80-year-old woman with type II diabetes mellitus was admitted to hospital with high-grade fever and leg pain for the previous three days. Physical examination revealed marked distention of the peripheral veins in both lower legs and she complained of pain. Spontaneous superficial suppurative thrombophlebitis was diagnosed and transfusion of cefazolin every 8 hours was started immediately after blood cultures. After 48 hours, the distention of the peripheral veins was improved; however, she suffered from a severe back pain thereafter. Two sets of blood culture yielded Group B streptococcus. Therefore the antibiotic was changed to ampicillin every 6 hours. To investigate the cause of back pain, MRI of the lumbar vertebral body was taken. Saggital gadolinium T1-weighted MRI demonstrated a high signal intensity lesion from Th7 to Th11, suggesting vertebral osteomyelitis following Group B streptococcal bacteremia from superficial suppurative thrombophlebitis. One week later, the clinical symptoms mostly disappeared. After six weeks of treatment, she was discharged. Suppurative thrombophlebitis is an inflammation of the vein wall by microorganisms and sometimes causes secondary metastatic abscess. Aging and diabetes are also risk factors for group B streptococcal invasive infection. This case suggests vertebral osteomyelitis should be taken into consideration during the course of group B streptococcal bacteremia in an elderly patient complaining back pain.
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PMID:[Group B streptococcal vertebral osteomyelitis following superficial suppurative thrombophlebitis]. 1707 95

The proportion of enterococcal infections caused by ampicillin-resistant Enterococcus faecium (AREfm) in a European hospital increased from 2% in 1994 to 32% in 2005, with prevalence rates of AREfm endemicity of up to 35% in at least six hospital wards. Diabetes mellitus, three or more admissions in the preceding year, and use of beta-lactams and fluoroquinolones, were all associated with AREfm colonisation. Of 217 AREfm isolates that were genotyped, 97% belonged to clonal complex 17 (CC17). This ecological change mimics events preceding the emergence of vancomycin-resistant E. faecium (VREF) in the USA and may presage the emergence of CC17 VREF in European hospitals.
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PMID:Ecological replacement of Enterococcus faecalis by multiresistant clonal complex 17 Enterococcus faecium. 1739 88

Streptococcus iniae, a common fish pathogen, rarely infects humans. In this report, a case of invasive S. iniae infection in a 51-year-old woman with diabetes mellitus and hepatitis C-related liver cirrhosis is described. The isolate was identified by 16S rDNA sequencing. The patient recovered after 1 week of treatment with ampicillin.
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PMID:Invasive infection with Streptococcus iniae in Taiwan. 1776 91

Patients with diabetes mellitus (DM) are prone to infection because glucose in the skin, urine, mucous membranes, and tears promotes growth of microorganisms. Conjunctival flora develops soon after birth, and some saprophytic conjunctival flora play a pathogenic role when immune function is compromised, which can lead to serious infection. DM is one condition that may compromise immune status. In lacrimal function tests of DM patients, a decrease in breakup time (BUT) of lacrimal film and a decrease in Schirmer's test results were seen. In the present study, conjunctival flora in patients with DM was compared with that in controls with regard to type and duration of diabetes and results of lacrimal function tests. Seventeen patients with type 1 DM (n=34 eyes), 66 patients with type 2 DM (n=132 eyes), and 50 control subjects (n=100 eyes) were included. The control group consisted of age-matched patients with no ophthalmologic problems other than refractive error. Glycosylated hemoglobin values were measured with highpressure liquid chromatography with the Hi-AUTOA1c analyzer (Kyoto Daiichi Kagatu Co., Ltd., Kyoto, Japan). Type and duration of diabetes and demographic data were recorded, and routine ophthalmologic examinations were performed; the BUT of lacrimal film was determined, and the results of Schirmer's test were assessed. Microbiologic sampling was performed twice for both eyes with sterile cotton swabs. One sample was incubated in 2 mL of brain-heart infusion broth agar; the other was incubated for the presence of fungi in Sabouraud dextrose agar. Colony morphology, hemolysis, and Gram's stain, as well as catalase, oxidase, and coagulase tests were performed. No growth was observed in 12 of 17 patients (35.4%) with type 1 DM, 28 of 66 patients (21.2%) with type 2 DM, and 25 of 50 control subjects (50%). Staphylococcus epidermidis (11.79%) and Staphylococcus aureus (11.7%) were the most frequently isolated organisms in the type 1 DM group, and S epidermidis (24.2%) and S aureus (21.2%) were the predominant organisms in the type 2 DM group. In control subjects, S epidermidis (22%), S aureus (12%), and Corynebacterium spp (10%) were the most frequently isolated organisms, and the number of eyes with growth of S aureus was significantly higher in the type 2 DM group than in the other groups (P<.01). Patients with diabetes are more prone to postoperative endophthalmitis than are nondiabetics, and preoperative application of antiseptic or antimicrobial agents to the conjunctiva may not sterilize the area. Impaired integrity of the posterior capsule may also increase the risk of endophthalmitis. Postoperative endophthalmitis is usually associated with gram-positive organisms (75%-80%); gram-negative organisms (15%-29%) and fungi (3%-13%) account for a smaller number of cases. A high rate of resistance to penicillin, ampicillin, and tetracycline was observed in S aureus isolates, although resistance to vancomycin was absent, rendering this molecule the most effective therapeutic option. In this study, S epidermidis and S aureus were the 2 most frequently isolated organisms in patients with DM. It is concluded that the conjunctival flora in diabetic subjects differs from that in nondiabetic subjects. This should be considered preoperatively and postoperatively, and prophylactic and postoperative treatment should be administered accordingly to diabetic patients.
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PMID:Conjunctival flora in patients with type 1 or type 2 diabetes mellitus. 1802 29

The aims of this study were the isolation and identification of Nocardia spp. from clinical samples of immunocompromised patients and patients with underlying diseases, and determination of antibiotic susceptibilities of the isolates. A total of 234 patients (172 male, 62 female; mean age: 58.6 +/- 15.9 years) of whom 126 (53.8%) with malignancy and 108 (46.2%) with other underlying diseases (pulmonary diseases, rheumatologic disorders, diabetes mellitus, chronic renal disfunction, cerebrovascular disorders and malnutrition) were included to the study. Biochemical characteristics, growth properties and antibiotic susceptibility patterns were used for the identification of the isolates. The distribution of specimens were as follows; sputum (124), tracheal aspirate (54), pleural fluid (27), bronchoalveolar lavage (23), abscess material (7) and lung biopsy (1) material. Nocardia spp were isolated from four out of 234 patients (1.7%), and two of them were identified as N. farcinica, one as N. asteroides and one as N. otitidiscaviarum. All of the four patients have had predisposing factors (hepatocellular carcinoma/diabetes mellitus; antiphospholipid syndrome/steroid use; nephrotic syndrome/ steroid use; chronic obstructive lung disease/lung cancer?), with a mean age of 52.5 years, and of them two were male. Nocardiosis has been presented as pulmonary infection in two of the cases, and brain and soft tissue abscesses in one of each patient. Kirby-Bauer disk diffusion, E-test and broth microdilution methods were used in order to detect the antibiotic susceptibilities of the strains. All isolates were found susceptible to imipenem and amikacin and resistant to erythromycin and ampicillin. One N. asteroides isolate was found susceptible to trimetoprim-sulphamethoxazole (TMP-SMX), whereas two N. farcinica and one N. otitidiscaviarum strains were resistant. The antibiotics to which N. farcinica isolates were susceptible were ceftriaxone and cefotaxime. As a result, since there is an increase in the number of immunocompromised patients recently, Nocardia spp. should be considered in such patients, and TMP-SMX should be used with care for empirical therapy.
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PMID:[Nocardia spp. isolated from immunocompromised patients in Trakya University Medical Faculty Hospital and their antibiotic susceptibilities]. 1817 71

We report a 77-year-old woman with Group B streptococcal bacteremia, subcutaneous abscess and reactive polyarthritis. Two years previously she suffered from atrial fibrillation and osteoarthritis of the knee. After she was admitted for treatment of the knee joint with hyaluronate sodium, she complained of pain in the left shoulder and both knees. Pyogenic arthritis was suspected and administration of cefazolin was started immediately after blood culture. One set of blood cultures showed Group B streptococcus. Therefore the antibiotic was changed to ampicillin. To investigate the cause of polyarthritis, enhanced CT of the left shoulder and both knees was performed and demonstrated fluid collection with marginal enhancement, suggesting a bacterial abscess. However, findings of arthrocentesis and synovial fluid culture were incompatible with bacterial arthritis. A subcutaneous abscess, which appeared at 5 days after admission to the hospital, was not connected to the synovial fluid, suggesting reactive arthritis was the main cause of her polyarthritis. We performed drainage surgery and one week later, the clinical symptoms and inflammatory findings mostly disappeared. Several microbes are able to cause reactive arthritis, however, cases with Group B streptococcus are very rare. Group B streptococcus infection should be taken into consideration not only in patients with diabetes and cerebrovascular disease but also in elderly patients.
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PMID:[An elderly case with group B streptococcal bacteremia, subcutaneous abscess and reactive polyarthritis]. 1819 61


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