Anti-Bacterial Agents ; therapeutic use ; Antibiotic Prophylaxis ; Dry Socket ; drug therapy ; etiology ; Humans ; Inflammation ; drug therapy ; Mandible ; Molar, Third ; microbiology ; surgery ; Surgical Wound Infection ; drug therapy ; etiology ; Tooth Extraction ; adverse effects ; Tooth, Impacted ; microbiology ; surgery

A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
Anti-Bacterial Agents/administration & dosage ; Cataract Extraction/adverse effects ; Citrobacter koseri/*isolation & purification ; Diagnosis, Differential ; Endophthalmitis/diagnosis/*microbiology/therapy ; Enterobacteriaceae Infections/diagnosis/*microbiology/therapy ; Eye Infections, Bacterial/diagnosis/*microbiology/therapy ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Lens Implantation, Intraocular/*adverse effects ; Male ; Microscopy, Acoustic ; Middle Aged ; Surgical Wound Infection/diagnosis/*microbiology/therapy ; Sutures/adverse effects/microbiology ; Visual Acuity ; Vitrectomy ; Vitreous Body/*microbiology

Although there have been a few reported cases of Enterococcal endophthalmitis, this is an unusual case of endophthalmitis complicated with corneal ulcer caused by Enterococcus faecalis. A 67-year-old male patient with diabetes mellitus underwent secondary intraocular lens implantation. Post-operative recovery was uneventful until a wound rupture was noted 3 weeks after the operation. On day 12 after the repair of the wound, endophthalmitis accompanied by wound necrosis and a fullthickness corneal ulcer was detected. His vision was light perception, and Enterococcus faecalis was identified by culture in samples of conjunctival sac, anterior chamber and vitreous humor. After 3 rounds of intravitreal antibiotics injection, the vitreous opacity disappeared on ultrasonographic finding but corneal opacity and corneal neovascularization still remained.
Aged ; Anti-Bacterial Agents/administration & dosage ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Enterococcus faecalis/drug effects/*isolation & purification ; *Eye Infections, Bacterial/diagnosis/drug therapy/microbiology ; Gram-Positive Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Microbial Sensitivity Tests ; Surgical Wound Infection/diagnosis/drug therapy/*microbiology ; Treatment Outcome

Adult ; Aged ; Antifungal Agents ; administration & dosage ; adverse effects ; classification ; Candida ; drug effects ; isolation & purification ; Carcinoma ; pathology ; therapy ; Cross Infection ; microbiology ; therapy ; Drug Resistance, Multiple, Fungal ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Mycoses ; microbiology ; therapy ; Patient Care Management ; methods ; Pulmonary Disease, Chronic Obstructive ; complications ; therapy ; Surgical Wound Infection ; microbiology ; therapy ; Symptom Flare Up ; Treatment Outcome

Scleral necrosis and infection are serious late complications of pterygium treatment and are difficult to manage. We describe a 70-year-old Chinese male who presented with scleral necrosis and Pseudomonas aeruginosa infection 15 years after the excision of a pterygium. The infection was treated early and aggressively with intensive topical and intravenous antibiotics and the thin necrotic sclera was reinforced with a donor scleral patch graft when the scleral infection was clinically controlled. The integrity of the globe was maintained by a thin layer of sclera anterior to the graft after the graft gradually shrunk in size and retracted posteriorly. The eye was saved from possible scleral perforation and endophthalmitis. This case is reported to highlight the importance of early aggressive treatment of infection and the value of prophylactic repair of scleral necrosis in the management of these late complications of pterygium treatment.
Administration, Topical ; Aged ; Anti-Bacterial Agents ; Drug Therapy, Combination ; administration & dosage ; therapeutic use ; Humans ; Injections, Intravenous ; Male ; Necrosis ; Pseudomonas Infections ; drug therapy ; Pseudomonas aeruginosa ; Pterygium ; surgery ; Sclera ; pathology ; transplantation ; Scleral Diseases ; drug therapy ; microbiology ; Surgical Wound Infection ; drug therapy ; etiology

Infectious scleritis by Pseudomonas aeruginosa is a well-known vision-threatening disease. In particular, scleral trauma following pterygium surgery may increase the risk of sclera inflammation. Surgical debridement and repair is necessary in patients who do not respond to medical treatments, such as topical and intravenous antibiotics. We reports herein the effectiveness of an autologous perichondrium conchal cartilage graft for infectious scleritis caused by Pseudomonas aeruginosa. This procedure was performed on four eyes of four patients with infectious scleritis who had previously undergone pterygium surgery at Gyeongsang National University Hospital (GNUH), Jinju, Korea from December 2011 to May 2012. Pseudomonas aeruginosa was identified in cultures of necrotic scleral lesion before surgery. The conchal cartilage perichondrium graft was transplanted, and a conjunctival flap was created on the scleral lesion. The autologous perichondrium conchal cartilage graft was successful and visual outcome was stable in all patients, with no reports of graft failure or infection recurrence. In conclusion, autologous perichondrium conchal cartilage graft may be effective in surgical management of Pseudomonal infectious scleritis when non-surgical medical treatment is ineffective. Further studies in larger, diverse populations are warranted to establish the effectiveness of the procedure.
Anti-Bacterial Agents/therapeutic use ; Autografts ; Cartilage/surgery ; Communicable Diseases ; Debridement ; Eye Infections, Bacterial/etiology/*therapy ; Female ; Humans ; Ophthalmologic Surgical Procedures ; Postoperative Complications ; Pseudomonas Infections/microbiology/*therapy ; Pseudomonas aeruginosa/*isolation & purification ; Pterygium/surgery ; Republic of Korea ; Sclera/*surgery/transplantation ; Scleritis/microbiology/*therapy ; Surgical Wound Infection/microbiology/*therapy ; Transplantation, Autologous ; Treatment Outcome

INTRODUCTIONThe prevalence of diabetes mellitus is high in Singapore. Infections of the lower limb are significant causes of morbidity in this population. Although the aerobic bacteriology of these infections is well-documented, there is less data available on the anaerobic pathogens involved. This study sets out to describe the anaerobic bacteria associated with diabetic foot infections, and evaluates the susceptibility to 3 antimicrobials with anaerobic activity.

MATERIALS AND METHODSAnaerobic culture was performed on operative samples taken from diabetic foot infections. Organisms were identified through standard microbiological methods and commercial identification kits. Antimicrobial susceptibility testing to clindamycin, metronidazole and imipenem was performed by agar dilution.

RESULTSOne hundred and two strains of strict anaerobic bacteria were isolated from 30 unique specimens. The predominant anaerobic isolates were Peptostreptococcus spp. (46%) and Bacteroides fragilis group (19%). Antibiotic resistance was detected for clindamycin (18%), metronidazole (1%) and imipenem (2%).

CONCLUSIONMultiple anaerobic species can be isolated from diabetic foot infections. A significant proportion of isolates are resistant to clindamycin, while resistance to imipenem and metronidazole remains low.

Anti-Bacterial Agents ; therapeutic use ; Bacteria, Aerobic ; drug effects ; genetics ; isolation & purification ; DNA, Bacterial ; analysis ; Diabetic Foot ; surgery ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Humans ; Nucleic Acid Amplification Techniques ; Retrospective Studies ; Surgical Wound Infection ; drug therapy ; microbiology

INTRODUCTIONInfection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.

METHODSBetween 2004 and 2008, we treated 11 patients with infected grade IIIB open tibial fractures in our unit. The management of infected grade IIIB open tibial fracture comprised three stages, which included serial debridement, wound closure by local flap surgery and bone reconstruction. The margin of resection and the type of bone reconstruction depended on the anatomical location of the disease, the extent of osteomyelitis and patient preference regarding treatment options. Bone reconstruction procedures included bone grafting, plating, interlocking nail, hybrid and monolateral external fixator, and Ilizarov bone transport.

RESULTSGram-negative organisms were isolated from all patients. Pseudomonas aeruginosa (P. aeruginosa) (44%) was the most common organism cultured. Infection was resolved in all patients. Nine fractures achieved union, with a mean union time of 15 months. Two patients with P. aeruginosa infection developed non-union of the fracture and refused additional surgery after three years of treatment.

CONCLUSIONThe multi-stage management approach is well-accepted and effective in controlling infection in infected grade IIIB open tibial fractures.

Adult ; Aged ; Aged, 80 and over ; Debridement ; methods ; Female ; Fracture Fixation ; methods ; Fractures, Open ; complications ; surgery ; Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique ; Malaysia ; Male ; Middle Aged ; Osteomyelitis ; etiology ; microbiology ; surgery ; therapy ; Prospective Studies ; Surgical Flaps ; Tibial Fractures ; complications ; surgery ; Treatment Outcome ; Wound Infection ; etiology ; microbiology ; surgery ; therapy

The major aims of this study were to estimate the infection rate and recognize the risk factor for ventriculoperitoneal (VP) shunt infections in children. To analyze shunt infection rate and identify risk factors, a retrospective cohort analysis of 333 consecutive VP shunt series was performed at Seoul National University Children's Hospital in Korea between January 2005 and February 2011. Overall, 35 shunts (10.5%) were infected, which represented an infection rate of 0.075 infection cases per shunt per year. VP shunt infection occurred at a median of 1 month (range, 6 days to 8 months) after insertion. An independent risk factor for shunt infection was undergoing an operation before the first year of life (relative risk 2.31; 95% confidence interval, 1.19-4.48). The most common causative microorganism was coagulase-negative staphylococci in 16 (45.7%) followed by Staphylococcus aureus in 8 (22.9%). Methicillin resistance rate was 83.3% among coagulase-negative staphylococci and S. aureus. In this study, cerebrospinal fluid shunt infection rate was 10.5%. Infection was frequently caused by methicillin-resistant coagulase-negative staphylococci and S. aureus within two months after shunt surgery. Vancomycin may be considered as the preoperative prophylaxis for shunt surgery in a situation where methicillin resistance rate is very high.
Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/drug therapy/*epidemiology/microbiology ; Child ; Child, Preschool ; Cohort Studies ; Humans ; Hydrocephalus/surgery ; Incidence ; Infant ; Infant, Newborn ; Male ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Retrospective Studies ; Risk Factors ; Staphylococcus/isolation & purification ; Surgical Wound Infection/drug therapy/*epidemiology/etiology ; Vancomycin/therapeutic use ; Ventriculoperitoneal Shunt/*adverse effects