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Sample records for baumannii implant-associated osteomyelitis

  1. Effects of Implant-Associated Osteomyelitis on Cefuroxime Bone Pharmacokinetics

    DEFF Research Database (Denmark)

    Tøttrup, Mikkel; Bue, Mats; Koch, Janne;

    2016-01-01

    Background: The prolonged antibiotic therapy that is often needed for successful management of osteomyelitis may be related to incomplete penetration of antibiotics into the target site. The objective of this study was to assess the effects of implant-associated osteomyelitis on cefuroxime...... penetration into bone.  Methods: Implant-associated osteomyelitis using a Staphylococcus aureus strain was induced in the right tibia in ten pigs. After five days and following administration of 1500 mg of cefuroxime, measurements of cefuroxime were obtained using microdialysis for eight hours in the implant...... cavity up to MICs of 2 mg/L compared with the other tissues, but the time was shorter for higher MICs.  Conclusions: Cefuroxime penetration into infected cancellous bone was incomplete but comparable with that in healthy bone. The destructive bone processes associated with acute osteomyelitis reduced...

  2. Biomaterials approaches to treating implant-associated osteomyelitis.

    Science.gov (United States)

    Inzana, Jason A; Schwarz, Edward M; Kates, Stephen L; Awad, Hani A

    2016-03-01

    Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative pathogen in chronic bone infections (osteomyelitis). Treatment of these chronic bone infections often involves combinations of antibiotics given systemically and locally to the affected site via a biomaterial spacer. The gold standard biomaterial for local antibiotic delivery against osteomyelitis, poly(methyl methacrylate) (PMMA) bone cement, bears many limitations. Such shortcomings include limited antibiotic release, incompatibility with many antimicrobial agents, and the need for follow-up surgeries to remove the non-biodegradable cement before surgical reconstruction of the lost bone. Therefore, extensive research pursuits are targeting alternative, biodegradable materials to replace PMMA in osteomyelitis applications. Herein, we provide an overview of the primary clinical treatment strategies and emerging biodegradable materials that may be employed for management of implant-related osteomyelitis. We performed a systematic review of experimental biomaterials systems that have been evaluated for treating established S. aureus osteomyelitis in an animal model. Many experimental biomaterials were not decisively more efficacious for infection management than PMMA when delivering the same antibiotic. However, alternative biomaterials have reduced the number of follow-up surgeries, enhanced the antimicrobial efficacy by delivering agents that are incompatible with PMMA, and regenerated bone in an infected defect. Understanding the advantages, limitations, and potential for clinical translation of each biomaterial, along with the conditions under which it was evaluated (e.g. animal model), is critical for surgeons and researchers to navigate the plethora of options for local antibiotic delivery.

  3. A novel porcine model of implant associated osteomyelitis: a comprehensive analysis of local, regional and systemic response

    DEFF Research Database (Denmark)

    Jensen, Louise Kruse; Koch, Janne; Dich-Jorgensen, Kirstine;

    2017-01-01

    Pigs are favorable experimental animals for infectious diseases in humans. However, implant associated osteomyelitis (IAO) models in pigs have only been evaluated using high-inoculum infection (>108 CFU) models in 1975 and 1993. Therefore, the aim of this paper was to present a new low inoculum...

  4. Early implant-associated osteomyelitis results in a peri-implanted bacterial reservoir.

    Science.gov (United States)

    Jensen, Louise Kruse; Koch, Janne; Aalbaek, Bent; Moodley, Arshnee; Bjarnsholt, Thomas; Kragh, Kasper Nørskov; Petersen, Andreas; Jensen, Henrik Elvang

    2017-01-01

    Implant-associated osteomyelitis (IAO) is a common complication in orthopedic surgery. The aim of this study was to elucidate how deep IAO can go into the peri-implanted bone tissue within a week. The study was performed in a porcine model of IAO. A small steel implant and either 10(4) CFU/kg body weight of Staphylococcus aureus or saline was inserted into the right tibial bone of 12 pigs. The animals were consecutively killed on day 2, 4 and 6 following implantation. Bone tissue around the implant was histologically evaluated. Identification of S. aureus was performed immunohistochemically on tissue section and with scanning electron microscopy and peptide nucleic acid in situ hybridization on implants. The distance of the peri-implanted pathological bone area (PIBA), measured perpendicular to the implant, was significantly larger in infected animals compared to controls (p = 0.0014). The largest differences were seen after 4 and 6 days of inoculation, where PIBA measurements of up to 6 mm were observed. Positive S. aureus bacteria were identified on implants and from 25 μm to 6 mm into PIBA. This is important knowledge for optimizing outcomes of surgical debridement in osteomyelitis.

  5. The diagnostic value of [{sup 18}F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection

    Energy Technology Data Exchange (ETDEWEB)

    Wenter, Vera; Albert, Nathalie L.; Lehner, Sebastian; Fendler, Wolfgang P.; Bartenstein, Peter [University of Munich, Department of Nuclear Medicine, Munich (Germany); Mueller, Jan-Phillip; Friederichs, Jan; Militz, Matthias; Hungerer, Sven [BG Trauma Center Murnau, Murnau (Germany); PMU Salzburg, Salzburg (Austria); Cyran, Clemens C. [University of Munich, Institute for Clinical Radiology, Munich (Germany); Hacker, Marcus [University of Vienna, Department of Nuclear Medicine, Vienna (Austria); Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

    2016-04-15

    The diagnosis of osteomyelitis and implant-associated infections in patients with nonspecific laboratory or radiological findings is often unsatisfactory. We retrospectively evaluated the contributions of [{sup 18}F]FDG PET and [{sup 18}F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. [{sup 18}F]FDG PET or PET/CT was performed in 215 patients with suspected osteomyelitis or implant-associated infections between 2000 and 2013. We assessed the diagnostic accuracy of both modalities together and separately with reference to intraoperative microbial findings, with a mean clinical follow-up of 69 ± 49 months. Infections were diagnosed clinically in 101 of the 215 patients. PET and PET/CT scans revealed 87 true-positive, 76 true-negative, 38 false-positive, and 14 false-negative results, indicating a sensitivity of 86 %, a specificity of 67 %, a positive predictive value (PPV) of 70 %, a negative predictive value (NPV) of 84 % and an accuracy of 76 %. The sensitivity of PET/CT was 88 %, but specificity, PPV, NPV and accuracy (76 %, 76 %, 89 % and 82 %, respectively) were higher than those of stand-alone PET. [{sup 18}F]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection. (orig.)

  6. Early implant-associated osteomyelitis results in a peri-implanted bacterial reservoir

    DEFF Research Database (Denmark)

    Jensen, Louise Kruse; Koch, Janne; Aalbæk, Bent

    2017-01-01

    weight of Staphylococcus aureus or saline was inserted into the right tibial bone of 12 pigs. The animals were consecutively killed on day 2, 4 and 6 following implantation. Bone tissue around the implant was histologically evaluated. Identification of S. aureus was performed immunohistochemically...... on tissue section and with scanning electron microscopy and peptide nucleic acid in situ hybridization on implants. The distance of the peri-implanted pathological bone area (PIBA), measured perpendicular to the implant, was significantly larger in infected animals compared to controls (p = 0.......0014). The largest differences were seen after 4 and 6 days of inoculation, where PIBA measurements of up to 6 mm were observed. Positive S. aureus bacteria were identified on implants and from 25 μm to 6 mm into PIBA. This is important knowledge for optimizing outcomes of surgical debridement in osteomyelitis....

  7. Efficacy of fosfomycin compared to vancomycin in treatment of implant-associated chronic methicillin-resistant Staphylococcus aureus osteomyelitis in rats.

    Science.gov (United States)

    Poeppl, Wolfgang; Lingscheid, Tilman; Bernitzky, Dominik; Schwarze, Uwe Y; Donath, Oliver; Perkmann, Thomas; Kozakowski, Nicolas; Plasenzotti, Roberto; Reznicek, Gottfried; Burgmann, Heinz

    2014-09-01

    Fosfomycin monotherapy was compared to therapy with vancomycin for the treatment of implant-associated methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis in an experimental rat model. The proximal tibiae were inoculated with 15 μl of a suspension containing 1×10(8) to 5×10(8) CFU/ml of a clinical isolate of MRSA with simultaneous insertion of a titanium wire. Four weeks later, treatment was started for 28 days with either 50 mg/kg of body weight vancomycin intraperitoneally twice daily (n=11) or 75 mg/kg fosfomycin intraperitoneally once daily (n=10). Eleven animals were left untreated. After treatment, quantitative cultures from bone were found to be positive for MRSA in all animals in the untreated group (median, 3.29×10(6) CFU/g of bone) and the vancomycin group (median, 3.03×10(5) CFU/g of bone). In the fosfomycin group, MRSA was detectable in 2 out of 10 (20%) animals (3.42×10(2) and 1.51×10(3) CFU/g of bone). Vancomycin was superior to the no-drug control (P=0.002), and fosfomycin was superior to the no-drug control and vancomycin (P<0.001). The cultures from the wires were positive in all untreated animals (median, 2.5×10(3) CFU/implant), in 10 animals in the vancomycin group (median, 1.15×10(3) CFU/implant), and negative in all animals in the fosfomycin group. Based on the bacterial counts from the implants, vancomycin was not superior to the no-drug control (P=0.324), and fosfomycin was superior to the no-drug control and vancomycin (P<0.001). No emergence of resistance was observed. In conclusion, it was demonstrated that fosfomycin monotherapy is highly effective for the treatment of experimental implant-associated MRSA osteomyelitis.

  8. Novel Therapies for Acinetobacter Osteomyelitis

    Science.gov (United States)

    2009-01-01

    Acinetobacter baumannii , Osteomyelitis, Colistin 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF...Words: Multi-Drug Resistant, Acinetobacter baumannii , Osteomyelitis, Colistin Page 1 of 21 John Wiley & Sons, Inc. Journal of Orthopaedic Research 1...which is responsible for >80% of OM infections, 12 Acinetobacter baumannii -calcoaceticus complex (ABC) are Gram-negative, non-fermentative, non-spore

  9. Osteomyelitis in Military Personnel Wounded in Iraq and Afghanistan

    Science.gov (United States)

    2008-02-01

    of Osteomyelitis Initial Episode n 103 (%) Recurrence n 36 (%) Any gram-negative bacteria* 94 (91) 12 (33) Acinetobacter baumannii -calcoaceticus...indicates male; F, female; Abc, Acinetobacter baumannii -calcoaceticus complex; E. coli, Eschericia coli; P. aeruginosa, Pseudomonas aeruginosa; CNS...Gray PJ. Multidrug-resistant Acinetobacter extremity infections in soldiers. Emerg Infect Dis. 2005;11:1218–1224. 8. Acinetobacter baumannii infections

  10. Salmonella Osteomyelitis.

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    McAnearney, S; McCall, D

    2015-10-01

    Salmonella infection can cause four predominant clinical syndromes: enteric fever, acute gastroenteritis, bacteraemia with or without metastatic infection, and the asymptomatic carrier state. Salmonella as an aetiological agent in osteomyelitis is essentially rare and salmonella osteomyelitis in itself is predominantly seen in patients with haemoglobinopathies such as sickle cell disease or thalassemia. There are very few cases reported in the literature in which salmonella osteomyelitis is seen in otherwise healthy individuals. We describe here a case of salmonella osteomyelitis in a young gentleman with no significant comorbidities who presented with fever and severe back pain, having returned from recent foreign travel. It is therefore important to consider uncommon pathogens in the differential diagnosis of travellers with prolonged fever and insidious symptoms.

  11. Granulicatella adiacens breast implant-associated infection.

    Science.gov (United States)

    del Pozo, Jose L; Garcia-Quetglas, Emilio; Hernaez, Silvia; Serrera, Alicia; Alonso, Marta; Pina, Luis; Leiva, Jose; Azanza, Jose Ramon

    2008-05-01

    The 1st reported case of breast implant-associated infection due to Granulicatella adiacens, formerly known as nutritionally variant streptococci, Streptococcus adiacens, and Abiotrophia adiacens is presented. Microbiology and previously reported cases of infections by this organism are reviewed.

  12. Gram-negative osteomyelitis: clinical and microbiological profile

    Directory of Open Access Journals (Sweden)

    Vladimir Cordeiro de Carvalho

    2012-02-01

    Full Text Available INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63%, with median age of 42 years, affected by chronic osteomyelitis (43% or acute osteomyelitis associated to open fractures (32%, the majority on the lower limbs (71%. The patients were treated with antibiotics as inpatients for 40 days (median and for 99 days (median in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%, Acinetobacter baumannii (21% e Pseudomonas aeruginosa (20%. Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

  13. Multimodality imaging of osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Elgazzar, A.H. [Cincinnati Univ. Medical Center, OH (United States); Abdel-Dayem, H.M. [Dept. Radiology, New York Medical College, Valhalla, NY (United States)]|[Dept. of Radiology, St. Vinvent`s Hospital and Medical Center, New York, NY (United States); Clark, J.D. [Cincinnati Univ. Medical Center, OH (United States); Maxon, H.R. [Cincinnati Univ. Medical Center, OH (United States)

    1995-09-01

    After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented. (orig.). With 13 figs., 9 tabs.

  14. 3D printed bioceramics for dual antibiotic delivery to treat implant-associated bone infection.

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    Inzana, J A; Trombetta, R P; Schwarz, E M; Kates, S L; Awad, H A

    2015-11-04

    Surgical implant-associated bone infections (osteomyelitis) have severe clinical and socioeconomic consequences. Treatment of chronic bone infections often involves antibiotics given systemically and locally to the affected site in poly (methyl methacrylate) (PMMA) bone cement. Given the high antibiotic concentrations required to affect bacteria in biofilm, local delivery is important to achieve high doses at the infection site. PMMA is not suitable to locally-deliver some biofilm-specific antibiotics, including rifampin, due to interference with PMMA polymerisation. To examine the efficacy of localised, combinational antibiotic delivery compared to PMMA standards, we fabricated rifampin- and vancomycin-laden calcium phosphate scaffolds (CPS) by three-dimensional (3D) printing to treat an implant-associated Staphylococcus aureus bone infection in a murine model. All vancomycin- and rifampin-laden CPS treatments significantly reduced the bacterial burden compared with vancomycin-laden PMMA. The bones were bacteria culture negative in 50 % of the mice that received sustained release vancomycin- and rifampin-laden CPS. In contrast, 100 % of the bones treated with vancomycin monotherapy using PMMA or CPS were culture positive. Yet, the monotherapy CPS significantly reduced the bacterial metabolic load following revision compared to PMMA. Biofilm persisted on the fixation hardware, but the infection-induced bone destruction was significantly reduced by local rifampin delivery. These data demonstrate that, despite the challenging implant-retaining infection model, co-delivery of rifampin and vancomycin from 3D printed CPS, which is not possible with PMMA, significantly improved the outcomes of implant-associated osteomyelitis. However, biofilm persistence on the fixation hardware reaffirms the importance of implant exchange or other biofilm eradication strategies to complement local antibiotics.

  15. Radionucleotide scanning in osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Sachs, W.; Kanat, I.O.

    1986-07-01

    Radionucleotide bone scanning can be an excellent adjunct to the standard radiograph and clinical findings in the diagnosis of osteomyelitis. Bone scans have the ability to detect osteomyelitis far in advance of the standard radiograph. The sequential use of technetium and gallium has been useful in differentiating cellulitis and osteomyelitis. Serial scanning with technetium and gallium may be used to monitor the response of osteomyelitis to antibiotic therapy.

  16. Effects of antiresorptive agents on osteomyelitis: novel insights into the pathogenesis of osteonecrosis of the jaw

    DEFF Research Database (Denmark)

    Li, Dan; Gromov, Kirill; Proulx, Steven T;

    2010-01-01

    The effects of antiresorptive agents (e.g., alendronate [Aln], osteoprotegerin [OPG]) on bone infection are unknown. Thus, their effects on implant-associated osteomyelitis (OM) were investigated in mice using PBS (placebo), gentamycin, and etanercept (TNFR:Fc) controls. None of the drugs affected...

  17. Chronic recurrent multifocal osteomyelitis

    NARCIS (Netherlands)

    Wedman, Jan; van Weissenbruch, Ranny

    2005-01-01

    We report what is, to our best knowledge, the first case of chronic recurrent multifocal osteomyelitis (CRMO) in which the frontal and sphenoid bones were involved. Characterized by a prolonged and fluctuating course of osteomyelitis at different sites, CRMO is self-limited, although sequelae can oc

  18. Charcot foot and ankle with osteomyelitis

    Directory of Open Access Journals (Sweden)

    Ryan Donegan

    2013-10-01

    Full Text Available This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.

  19. Osteomyelitis in horses.

    Science.gov (United States)

    Goodrich, Laurie R

    2006-08-01

    Much has been learned in the past decade about osteomyelitis. The inhibitory mechanisms of the "biofilm slime" layer that is formed by bacterial extracapsular exopolysaccharides and binds to bone, joints, and implants are now better understood than in the past. The surface colonization of bacteria that occurs within these biofilms is a biologic phenomenon that is somewhat unique to orthopedic infections. This survival strategy of bacteria is effective, and it is important for veterinarians who treat osteomyelitis to be aware of current diagnostic and therapeutic treatment modalities. The practitioner should be aware of the most common bacteria associated with osteomyelitis and the traditional treatments that are still used. Current therapeutic treatment modalities, such as antibiotic- impregnated polymethylmethacrylate, antibiotic-impregnated plaster of Paris, and regional perfusion, have become routine, however, and have been responsible for improving the prevention and outcome of osteomyelitis in the horse. It is the intent of this article to make equine veterinarians aware of current information as well as the future treatments of osteomyelitis.

  20. Therapy of haematogenous osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, Louise Kruse; Koch, Janne; Kirketerp-Møller, Klaus;

    2013-01-01

    It is generally accepted that surgery is necessary for the proper treatment of chronic haematogenous osteomyelitis (HO) in children. However, the correct timing of surgery and the technique most effective for debridement of infectious bone tissue is debated. Theoretically, large animal models of HO...

  1. Osteomyelitis in turkeys

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    Turkey osteomyelitis complex (TOC) is a condition in which apparently healthy, usually male birds have infections that are hidden in their bones, joints, and muscles. Some of these birds have a green liver, which provides a method for detecting these carcasses in the processing plant. Our research h...

  2. Lymfom fejltolket som osteomyelitis

    DEFF Research Database (Denmark)

    Brand, Eske; Klit, Jakob

    2015-01-01

    Patients are admitted based on a tentative diagnosis. If that is incorrect it may have negative consequences for the patient and the system. In this case we present an eight-month elucidation with several diagnostic procedures with a tentative diagnosis of osteomyelitis. This diagnosis was kept...

  3. A novel hydroxyapatite film coated with ionic silver via inositol hexaphosphate chelation prevents implant-associated infection

    Science.gov (United States)

    Funao, Haruki; Nagai, Shigenori; Sasaki, Aya; Hoshikawa, Tomoyuki; Tsuji, Takashi; Okada, Yasunori; Koyasu, Shigeo; Toyama, Yoshiaki; Nakamura, Masaya; Aizawa, Mamoru; Matsumoto, Morio; Ishii, Ken

    2016-03-01

    Various silver-coated implants have been developed to prevent implant-associated infections, and have shown dramatic effects in vitro. However, the in vivo results have been inconsistent. Recent in vitro studies showed that silver exerts antibacterial activity by mediating the generation of reactive oxygen species in the presence of oxygen. To maintain its antibacterial activity in vivo, the silver should remain in an ionic state and be stably bound to the implant surface. Here, we developed a novel bacteria-resistant hydroxyapatite film in which ionic silver is immobilized via inositol hexaphosphate chelation using a low-heat immersion process. This bacteria-resistant coating demonstrated significant antibacterial activity both in vitro and in vivo. In a murine bioluminescent osteomyelitis model, no bacteria were detectable 21 days after inoculation with S. aureus and placement of this implant. Serum interleukin-6 was elevated in the acute phase in this model, but it was significantly lower in the ionic-silver group than the control group on day 2. Serum C-reactive protein remained significantly higher in the control group than the ionic-silver group on day 14. Because this coating is produced by a low-heat immersion process, it can be applied to complex structures of various materials, to provide significant protection against implant-associated infections.

  4. Chronic Pseudomonas aeruginosa cervical osteomyelitis

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    Sujeet Kumar Meher

    2016-01-01

    Full Text Available Pseudomonas aeruginosa is a rare cause of osteomyelitis of the cervical spine and is usually seen in the background of intravenous drug use and immunocompromised state. Very few cases of osteomyelitis of the cervical spine caused by pseudomonas aeruginosa have been reported in otherwise healthy patients. This is a case presentation of a young female, who in the absence of known risk factors for cervical osteomyelitis presented with progressively worsening neurological signs and symptoms.

  5. Maxillary Osteomyelitis: A Rare Entity

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    Ayaaz Habib

    2016-01-01

    Full Text Available Osteomyelitis of the maxilla is now a rare event with the advent of antibiotics. The two predominant causes are odontogenic infections and sinusitis. Immunocompromised states such as diabetes, HIV, and malnutrition increase the risk of osteomyelitis. It is important to recognize this early as it is a difficult entity to treat with potentially serious consequences. We report an unusual case of right sided maxillary osteomyelitis in a lady with poorly controlled diabetes in rural Lincolnshire. Biopsy of the right maxillary bone showed features of acute osteomyelitis. This responded well to a prolonged course of oral antibiotics.

  6. Nanocidals therapy for osteomyelitis

    Science.gov (United States)

    Qadri, Shahnaz Majid

    Infection is a major medical problem that causes serious complications including patient death. The mortality rate of invasive infection has reduced significantly since the introduction of antibiotherapy. However, the resistance to antibiotic is becoming a serious medical problem that resulted in high medical cost. The overall aim of this study is to evaluate a potential inorganic route (metalo-antibiotic) to treat localized infections that require long-term antibiotic treatment combined with medical and surgical intervention. In this study osteomyelitis (bone infection) was selected as a model to evaluate the inorganic route to treat infection. Osteomyelitis is a progressive infection that could result in amputation and patient death. The metalo-antibiotics are faster to develop than antibiotics and have shown great efficacy against a wide range of bacterial infection. A unique composition of particles with ability to extend their residual efficacy on bacteria for an extended time compared to conventional antibiotics was synthesized and evaluated in this study. The in vitro experiments demonstrated the metalo-antibiotics to treat cellular internal infections without damaging the home cell. The in vivo toxicity experiments demonstrated a tolerance of the particles for doses that are 20 times higher than the anticipated treatment dose. A murine mouse model for osteomyelitis was developed. The efficacy of the metalo-antibiotics on the induced osteomyelitis was evaluated. A significant decrease in infection in the bones treated with nanoparticles was observed. By delivering optimal concentration of nanoparticles in mouse models there was no sign of pathology seen in mouse. Overall, this study has two main impacts: a) creation of inorganic routes to fight against bacterial infection particularly those requiring long-term antibiotic or surgical treatment b) reduction of critical technical risk through generation of pre-clinical data of the employment of inorganic

  7. Charcot foot and ankle with osteomyelitis

    OpenAIRE

    Donegan, Ryan; Sumpio, Bauer; Peter A. Blume

    2013-01-01

    This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.Keywords: Charcot foot; osteomyelitis; diabetes mellitus; infection; neuropathy(Published: 1 October 2013)Citation: Diabetic Foot & Ankle 2013, 4: 21361 - http://dx.doi.org/10.3402/dfa.v4i0.21361

  8. Fungal arthritis and osteomyelitis.

    Science.gov (United States)

    Kohli, Rakhi; Hadley, Susan

    2005-12-01

    Fungal arthritis and osteomyelitis are uncommon diseases and generally present in an indolent fashion. The incidence of fungal bone and joint dis-ease is increasing with an increase in the prevalence of factors predisposing to invasive fungal disease, such as the use of central venous catheters, broad spectrum antibiotics, immunosuppression, and abdominal surgery. Definitive diagnosis relies on bone or synovial culture or biopsy. Successful management has traditionally consisted of amphotericin B in combination with surgical debridement. Given the rarity of this disease, treatment is not well defined, but reports of success with the use of azole antifungal agents, including itraconazole, fluconazole, voriconazole, and posaconazole, are promising.

  9. [Chronic recurrent multifocal osteomyelitis].

    Science.gov (United States)

    Schilling, F; Eckardt, A; Kessler, S

    2000-01-01

    The aim of this paper is to give a detailed description of the so-called "chronic recurrent multifocal osteomyelitis" (CRMO). The clinical, radiological and histopathological results of an analysis of 29 cases (15 children/adolescents and 14 adults) are presented and correlated to current data from the literature. We could delinate the following points: 1. CRMO is a systemic aseptic inflammation of the bone marrow (Osteitis), it can occur polytopically and association with pustulous dermatologic symptoms is possible. 2. It is not a rare disease 3. Osteomyelitis is probably "reactive" and a plasma-cell sclerotic process with ist own characteristic histologic three-phase course. 4. We could observe 5 specific types of localization which can be documented by X-ray or bone scan. 5. Accompanying arthritis os often present, especially "sympathetic coxitis". 6. The use of drugs in treatment of CRMO (i.e. azithromycin, calcitonin, and bisphosphonates) is discussed. In conclusion we want to point out, that 1. 99mTC bone scan should always be performed when there is suspicion for CRMO to reveal the pattern of affection, 2. the rheumatologist and dermatologist should be contacted, 3. operation is normally not necessary for treatment of the mostly self-limitin disease, and 4. the term "SAPHO syndrome" should be avoided, further differentiation of the diagnosis is necessary.

  10. Osteomyelitis: a current challenge

    Directory of Open Access Journals (Sweden)

    Luciana Souza Jorge

    2010-06-01

    Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

  11. Vertebral osteomyelitis without disc involvement

    Energy Technology Data Exchange (ETDEWEB)

    Kamani, I.; Syed, I.; Saifuddin, A. E-mail: asaifuddin@aol.com; Green, R.; MacSweeney, F

    2004-10-01

    Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.

  12. Tuberculous sternal osteomyelitis.

    Science.gov (United States)

    Cataño, Juan Carlos; Galeano, Daniela; Botero, Juan Camilo

    2014-10-01

    A 32-year-old female patient with systemic lupus erythematosus presented with 1 month of nocturnal subjective fevers, night sweats, poor appetite, malaise, 8-kg weight loss, and a 6-cm painful sternal mass. She had normal vital signs with a physical examination notable only for the presence of a fluctuating sternal mass. A computed tomographic scan of the thorax showed a 67 × 32 × 27-mm sternal mass associated with severe sternal osteomyelitis (Fig. 1); then a surgical drainage was performed, and abundant caseous material was removed, leaving a penrose drain (Fig. 2). Histologic examination of the bone tissue revealed extensive necrosis and granulomas with multinucleated giant cells. The bone, secretion, and soft tissue were negative for acid-fast bacillae on Ziehl-Neelsen stain; but culture grew Mycobacterioum tuberculosis, and she was started on 4 first-line antituberculosis medications, showing rapid symptomatic improvement, and was discharged 4 weeks after admission (Fig. 3).

  13. The Acinetobacter baumannii group: a systemic review

    OpenAIRE

    Zhang, Hua-Zhong; Zhang, Jin-Song; Qiao, Li

    2013-01-01

    BACKGROUND: The Acinetobacter baumannii group, including Acinetobacter baumannii, Acinetobacter genomospecies 3 and 13TU, is phenotypically indistinguishable and uniformly identified as Acinetobacter baumannii by laboratories of clinical microbiology. This review aimed to demonstrate the differences among them. METHODS: Literatures associated with the Acinetobacter baumannii group were identified and selected from PubMed databases and relevant journals. RESULTS: Acinetobacter genospecies 3 an...

  14. Laboratory Maintenance of Acinetobacter baumannii.

    Science.gov (United States)

    Jacobs, Anna C; Zurawski, Daniel V

    2014-11-03

    Acinetobacter baumannii has recently drawn great interest in the microbiology research community due to the increase in clinical antibiotic resistance of this organism, and persistence of this bacterial species in the hospital environment. This unit outlines protocols for the growth and maintenance of A. baumannii in the laboratory.

  15. 38 CFR 4.43 - Osteomyelitis.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Osteomyelitis. 4.43... DISABILITIES Disability Ratings The Musculoskeletal System § 4.43 Osteomyelitis. Chronic, or recurring, suppurative osteomyelitis, once clinically identified, including chronic inflammation of bone marrow,...

  16. Chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Roderick, Marion R; Ramanan, Athimalaipet V

    2013-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease occurring primarily in children and adolescents. Episodes of systemic inflammation occur due to immune dysregulation without autoantibodies, pathogens or antigen-specific T cells. CRMO is characterised by the insidious onset of pain with swelling and tenderness over the affected bones. Clavicular involvement was the classical description; however, the metaphyses and epiphyses of long bones are frequently affected. Lesions may occur in any bone, including vertebrae. Characteristic imaging includes bone oedema, lytic areas, periosteal reaction and soft tissue reaction. Biopsies from affected areas display polymorphonuclear leucocytes with osteoclasts and necrosis in the early stages. Subsequently, lymphocytes and plasma cells predominate followed by fibrosis and signs of reactive new bone forming around the inflammation. Diagnosis is facilitated by the use of STIR MRI scanning, potentially obviating the need for biopsy and unnecessary long-term antibiotics due to incorrect diagnosis. Treatment options include non-steroidal anti-inflammatory drugs and bisphosphonates. Biologics have been tried in resistant cases with promising initial results. Gene identification has not proved easy although research in this area continues. Early descriptions of the disease suggested a benign course; however, longer-term follow up shows that it can cause significant morbidity and longer-term disability. Although it has always been thought of as very rare, the prevalence is likely to be vastly underestimated due to poor recognition of the disease.

  17. Garre′s sclerosing osteomyelitis

    Directory of Open Access Journals (Sweden)

    Suma R

    2007-05-01

    Full Text Available Garre′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults. This disease entity is well-described in dental literature and is commonly associated with an odontogenic infection resulting from dental caries. This paper describes a case of Garre′s osteomyelitis in a 10-year-old boy, in whom the condition arose following pulpoperiapical infection in relation to permanent mandibular right first molar. Clinically the patient presented with bony hard, non-tender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. The elimination of periapical infection was achieved by endodontic therapy and the complete bone remodeling was seen radiographically after three months follow-up.

  18. Cryptococcal osteomyelitis in the ribs

    Directory of Open Access Journals (Sweden)

    Sethi Somika

    2010-01-01

    Full Text Available Isolated cryptococcal osteomyelitis, in an immunocompetent, is rare and only a few cases have been reported in literature. We present the case of a 30-year-old man presented with pain on the left side of chest with fever and gradually increasing swelling in left lateral lower aspect of chest. Investigation revealed a lytic lesion in the anterior end of left 6 th rib with normal CD4 count. He was tested negative for HIV antigen. Excision of the sixth rib, morphologically revealed cryptococcal osteomyelitis and the patient was given anti-fungal treatment for six months.

  19. Aspergillus Osteomyelitis of the Skull.

    Science.gov (United States)

    Nicholson, Simon; King, Richard; Chumas, Paul; Russell, John; Liddington, Mark

    2016-07-01

    Osteomyelitis of the craniofacial skeleton is rare, with fungal pathogens least commonly implicated. The authors present 2 patients of osteomyelitis of the skull caused by Aspergillus spp. and discuss the diagnosis, clinicopathological course, and management strategies.Late recurrence seen in this type of infection warrants long-term follow-up and a high index of suspicion for the clinical signs associated with recurrence.Such patients would benefit from their surgical debridement being planned and managed via a specialist craniofacial unit, so as to utilize the most aesthetically sensitive approach and the experience of specialists from several surgical disciplines.

  20. Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult.

    Science.gov (United States)

    Yoon, Kyeong-Wook; Kim, Young-Jin

    2015-04-01

    Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A 53-year-old male who had no significant medical history was admitted due to complaints of back pain radiating to the flank for the last 3 months, followed by a progressive motor weakness of both lower limbs. Lumbar magnetic resonance imaging (MRI) demonstrated osteomyelitis and diskitis, suspected to be a pyogenic condition rather than a tuberculosis infection. Despite antibiotic treatment for several weeks, the symptoms worsened, and finally, open surgery was performed. Surgical biopsy revealed an Aspergillus infection and medical treatment with amphotericin B was started. It can be diagnosed early through an MRI; biopsy is very important but difficult, and making the correct differential diagnosis is essential for avoiding unexpected complications. The authors report a case of lumbar Aspergillus osteomyelitis in an immunocompetent adult and reviewed previously described cases of spinal aspergillosis.

  1. Spinal osteomyelitis caused by Proteus mirabilis in a child

    NARCIS (Netherlands)

    deWeerd, W; Kimpen, JLL; Miedema, CJ

    1997-01-01

    Osteomyelitis due to Proteus mirabilis is rare. Spinal osteomyelitis caused by this organism has only been described in adults. This is the first paediatric case of P. mirabilis vertebral osteomyelitis.

  2. Diversity of acinetobacter baumannii isolates from Egypt

    OpenAIRE

    Al-Hassan, Leena

    2013-01-01

    Acinetobacter baumannii is an important nosocomial pathogen, frequently associated with morbidity and mortality in immunocompromised patients due to the immuno-ablative treatments, neutropenia and prolonged hospitalization. The ability of A. baumannii to survive in the healthcare setting makes it a frequent problematic pathogen in cancer centres. Much of the interest in A. baumannii has been attributed to its remarkable rapid acquisition of resistance mechanisms A. baumannii is...

  3. Management of osteomyelitis of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Benecke, J.E. Jr. (Otologic Medical Group, Inc., Los Angeles, CA (USA))

    1989-12-01

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

  4. Fungal osteomyelitis and septic arthritis.

    Science.gov (United States)

    Bariteau, Jason T; Waryasz, Gregory R; McDonnell, Matthew; Fischer, Staci A; Hayda, Roman A; Born, Christopher T

    2014-06-01

    Management of fungal osteomyelitis and fungal septic arthritis is challenging, especially in the setting of immunodeficiency and conditions that require immunosuppression. Because fungal osteomyelitis and fungal septic arthritis are rare conditions, study of their pathophysiology and treatment has been limited. In the literature, evidence-based treatment is lacking and, historically, outcomes have been poor. The most common offending organisms are Candida and Aspergillus, which are widely distributed in humans and soil. However, some fungal pathogens, such as Histoplasma, Blastomyces, Coccidioides, Cryptococcus, and Sporothrix, have more focal areas of endemicity. Fungal bone and joint infections result from direct inoculation, contiguous infection spread, or hematogenous seeding of organisms. These infections may be difficult to diagnose and eradicate, especially in the setting of total joint arthroplasty. Although there is no clear consensus on treatment, guidelines are available for management of many of these pathogens.

  5. Osteomyelitis in the diabetic foot

    OpenAIRE

    Malhotra, Rishi; Chan, Claire Shu-Yi; Nather, Aziz

    2014-01-01

    Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer. Medical imaging studies include plain radiographs, magnetic resonance imaging, and bone scintigraphy. A high index of suspicion is also required to make the...

  6. Clinical implications of glycoproteomics for Acinetobacter baumannii.

    Science.gov (United States)

    Kinsella, Rachel L; Scott, Nichollas E; Feldman, Mario F

    2015-02-01

    The opportunistic human pathogen Acinetobacter baumannii persists in the healthcare setting because of its ability to survive exposure to various antimicrobial and sterilization agents. A. baumannii's ability to cause multiple infection types complicates diagnosis and treatment. Rapid detection of A. baumannii infections would likely improve treatment outcomes. Recently published Acinetobacter glycoproteomic data show the prevalence of O-linked glycoproteins, suggesting the possibility for an O-glycan-based detection technology. O-glycan biosynthesis is required for protein glycosylation and capsular polysaccharide production in A. baumannii. Recent publications demonstrate key roles for protein glycosylation and capsular polysaccharide in the pathogenicity of A. baumannii. Targeted antimicrobial development against O-glycan biosynthesis may produce new effective treatment options for A. baumannii infections. Here, we discuss how the data gathered through Acinetobacter glycoproteomics can be used to develop technologies for rapid diagnosis and reveal potential antimicrobial targets. In addition, we consider the efficacy of glycoconjugate vaccine development against A. baumannii.

  7. Biofilm formation in Acinetobacter baumannii.

    Science.gov (United States)

    Longo, Francesca; Vuotto, Claudia; Donelli, Gianfranco

    2014-04-01

    Acinetobacter baumannii has received much attention in recent years because of its increasing involvement in a number of severe infections and outbreaks occurring in clinical settings, and presumably related to its ability to survive and persist in hospital environments. The treatment of infections caused by A. baumannii nosocomial strains has become increasingly problematic, due to their intrinsic and/or acquired resistance to multiple classes of antibiotics. Furthermore, the demonstrated ability of nosocomial strains to grow as biofilm is believed to play a significant role in their persistence and antibiotic resistance. This review summarises current knowledge on A. baumannii biofilm formation and its clinical significance, as well as the related genetic determinants and the regulation of this process.

  8. Nuclear medicine imaging of posttraumatic osteomyelitis

    NARCIS (Netherlands)

    Govaert, G.A.M.; Glaudemans, A W J M

    2016-01-01

    INTRODUCTION: Early recognition of a possible infection and therefore a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO). However, at this moment there is no single routine test available that can detect osteomyelitis beyond doubt a

  9. Vertebral osteomyelitis: clinical features and diagnosis.

    Science.gov (United States)

    Eren Gök, S; Kaptanoğlu, E; Celikbaş, A; Ergönül, O; Baykam, N; Eroğlu, M; Dokuzoğuz, B

    2014-10-01

    We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p 15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

  10. Gambaran Roentgenologi Diffuse Sclerosing Osteomyelitis Pada Mandibula

    OpenAIRE

    Yolanda, Desri

    2008-01-01

    Osteomielitis pada rahang adalah suatu penyakit yang disebabkan penyebaran radang yang meliputi bagian-bagian dari pada tulang rahang. Osteomielitis dapat diartikan sebagai peradangan pada tulang dan sumsum tulang yang pada dasarnya merupakan infeksi mikroorganisme. Dahulu penyakit ini sangat ditakuti orang, karena akibat yang ditimbulkannya dapat menyebabkan kematian. Osteomilitis dapat diklasifikasikan menjadi dua yaitu suppurative osteomyelitis dan non suppurative osteomyelitis. Salah ...

  11. Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei

    DEFF Research Database (Denmark)

    Kaldau, Niels Christian; Brorson, Stig; Jensen, Poul Einar

    2012-01-01

    We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis.......We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis....

  12. Osteomyelitis with proliferative periostitis: an unusual case.

    Science.gov (United States)

    Tong, Antonio C K; Ng, Irene O L; Yeung, K M Au

    2006-11-01

    Chronic osteomyelitis with subperiosteal new bone formation results from periosteal reaction to chronic inflammatory/infectious stimulation. In the maxillofacial region, it has traditionally been termed Garrè's osteomyelitis with proliferative periostitis and more recently periostitis ossificans. The term Garrè's osteomyelitis has been regarded as a misnomer by many authors in the recent literature. The term chronic osteomyelitis with proliferative periostitis, although cumbersome, is considered to be the most accurate description of the pathology. It usually affects the mandible of young patients secondary to dental infection. Management involves removal of the source of infection and antibiotic treatment. We present an unusual case of chronic osteomyelitis with proliferative periostitis affecting the mandible of a 12-year-old patient. The source of infection was related to the developing lower left third molar, which had apparently no communication with the oral cavity.

  13. Epidemiology of acute vertebral osteomyelitis in Denmark

    DEFF Research Database (Denmark)

    Krogsgaard, M R; Wagn, P; Bengtsson, J

    1998-01-01

    We studied the epidemiology of acute, non-tuberculous, hematogenous vertebral osteomyelitis in Denmark during 1978-1982. 137 patients fulfilled the criteria for acute vertebral osteomyelitis. The incidence was 5/mill/year. There were no cases in the age group 20-29 years. The highest incidence......-1993, the relative number of reported patients with vertebral osteomyelitis had increased in the age group 20-49 years, compared to 1978-1982, but the incidence was highest in the group aged 60-79 years....

  14. A doxycycline-loaded polymer-lipid encapsulation matrix coating for the prevention of implant-related osteomyelitis due to doxycycline-resistant methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Metsemakers, Willem-Jan; Emanuel, Noam; Cohen, Or; Reichart, Malka; Potapova, Inga; Schmid, Tanja; Segal, David; Riool, Martijn; Kwakman, Paulus H S; de Boer, Leonie; de Breij, Anna; Nibbering, Peter H; Richards, R Geoff; Zaat, Sebastian A J; Moriarty, T Fintan

    2015-07-10

    Implant-associated bone infections caused by antibiotic-resistant pathogens pose significant clinical challenges to treating physicians. Prophylactic strategies that act against resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), are urgently required. In the present study, we investigated the efficacy of a biodegradable Polymer-Lipid Encapsulation MatriX (PLEX) loaded with the antibiotic doxycycline as a local prophylactic strategy against implant-associated osteomyelitis. Activity was tested against both a doxycycline-susceptible (doxy(S)) methicillin-susceptible S. aureus (MSSA) as well as a doxycycline-resistant (doxy(R)) methicillin-resistant S. aureus (MRSA). In vitro elution studies revealed that 25% of the doxycycline was released from the PLEX-coated implants within the first day, followed by a 3% release per day up to day 28. The released doxycycline was highly effective against doxy(S) MSSA for at least 14days in vitro. A bolus injection of doxycycline mimicking a one day release from the PLEX-coating reduced, but did not eliminate, mouse subcutaneous implant-associated infection (doxy(S) MSSA). In a rabbit intramedullary nail-related infection model, all rabbits receiving a PLEX-doxycycline-coated nail were culture negative in the doxy(S) MSSA-group and the surrounding bone displayed a normal physiological appearance in both histological sections and radiographs. In the doxy(R) MRSA inoculated rabbits, a statistically significant reduction in the number of culture-positive samples was observed for the PLEX-doxycycline-coated group when compared to the animals that had received an uncoated nail, although the reduction in bacterial burden did not reach statistical significance. In conclusion, the PLEX-doxycycline coating on titanium alloy implants provided complete protection against implant-associated MSSA osteomyelitis, and resulted in a significant reduction in the number of culture positive samples when challenged with a

  15. Implant-associated anaplastic large cell lymphoma of the breast: Insight into a poorly understood disease.

    Science.gov (United States)

    Weathers, William M; Wolfswinkel, Erik M; Hatef, Daniel A; Lee, Edward I; Hollier, Larry H; Brown, Rodger H

    2013-01-01

    Implant-associated anaplastic large cell lymphoma (ALCL) is the subject of much debate in the field of plastic surgery. Only a few published cases have been reported and the rarity of the disease may make proving causality exceedingly difficult. Despite this, it is of utmost importance that full attention be devoted to this subject to ensure the safety and well-being of patients. The authors report one new case of implant-associated ALCL that recently presented to their institution. Implant-associated ALCL is a poorly understood disease. It should likely be considered its own clinical entity and categorized into two subtypes: one presenting as a seroma and the other as a distinct mass or masses. When reported, only textured implants have been associated with ALCL. The United States Food and Drug Administration and American Society of Plastic Surgeons have initiated a registry and have collected critical data to gain further understanding of this disease.

  16. Insights into Acinetobacter baumannii pathogenicity.

    Science.gov (United States)

    Cerqueira, Gustavo M; Peleg, Anton Y

    2011-12-01

    Acinetobacter spp. have justifiably received significant attention from the public, scientific, and medical communities. Over recent years, Acinetobacter, particularly Acinetobacter baumannii, has become a "red-alert" human pathogen, primarily because of its exceptional ability to develop resistance to all currently available antibiotics. This characteristic is compounded by its unique abilities to survive in a diverse range of environments, including those within healthcare institutions, leading to problematic outbreaks. Historically, the virulence of the organism has been questioned, but recent clinical reports suggest that Acinetobacter can cause serious, life-threatening infections. Furthermore, its metabolic adaptability gives it a selective advantage in harsh hospital environments. This review focuses on current understanding of A. baumannii pathogenesis and the model systems used to study this interesting organism.

  17. A Case of Aerococcus Urinae Vertebral Osteomyelitis

    Science.gov (United States)

    Jerome, Michael; Slim, Jihad; Sison, Raymund; Marton, Randy

    2015-01-01

    Aerococcus urinae is an aerobic, alpha hemolytic gram positive coccus bacterium that grows in pairs or clusters. We report the first case of vertebral osteomyelitis due to A. urinae. This has not been previously reported in the literature. PMID:26069429

  18. Management of melioidosis osteomyelitis and septic arthritis.

    Science.gov (United States)

    Shetty, R P; Mathew, M; Smith, J; Morse, L P; Mehta, J A; Currie, B J

    2015-02-01

    Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis. We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse. We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048). More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.

  19. Osteomyelitis of the Mandible in an Adolescent.

    Science.gov (United States)

    Di Fiore, Peter M; Cerrud, Clinio C; Buckley, Ian A; Demian, Nagi M

    2015-01-01

    A 13-year-old female, who had been experiencing episodes of mandibular pain and swelling for approximately six months, was referred to a university urgent care dental clinic for evaluation after receiving endodontic treatment. At the referral examination, clinical and radiographic findings were suggestive of osteomyelitis. The purpose of this report is to present the possible etiology, clinical and radiographic findings and surgical management of mandibular osteomyelitis in an adolescent patient.

  20. Eosinophilia due to osteomyelitis in a dog.

    Science.gov (United States)

    Dehghani, Seifollah N; Hajighahramani, Shahin

    2005-09-01

    A dog with a lesion in the left elbow area and presence of purulent materials was referred to hospital; history, clinical examination, laboratory test and radiological evaluation of the dog proved the presence of osteomyelitis. Eosinophilia was evident by haematologic test. Intensive antibiotic, anti-inflammatory medication, local wound management and restricted physical activity, improved osteomelitis condition and reduced eosinophil number. Therefore it seemed that osteomyelitis was the cause of eosinophilia in this dog.

  1. Periostitis and osteomyelitis in chronic drug addicts

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, C.R.; Lawson, J.P.

    1986-03-01

    Periostitis and osteomyelitis can occur in drug addicts not only by hematogeneous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss.

  2. Osteomyelitis caused by Achromobacter xylosoxidans

    Directory of Open Access Journals (Sweden)

    Takashi Shinha

    2015-01-01

    Full Text Available Achromobacter xylosoxidans is an aerobic, nonfermenting gram-negative rod and described as a waterborne bacterium since it habits aquatic environments ubiquitously. It has frequently been isolated from aquatic surroundings in the hospital and from various human body sites. Although occasionally considered a non-pathogen, A. xylosoxidans has been associated with outbreaks of nosocomial infection due to contaminated fluids. Moreover, a wide variety of infectious etiologies due to A. xylosoxidans has been reported primarily in immunocompromised individuals. Heightened awareness of this bacterium and associated clinical importance is warranted for clinicians since its broad disease spectrum in humans and frequent multi-drug resistance may result in an increased mortality rate. In this report, we describe a case of osteomyelitis caused by A. xylosoxidans in a patient with a history of diabetes mellitus.

  3. Osteomyelitis caused by Achromobacter xylosoxidans.

    Science.gov (United States)

    Shinha, Takashi; Oguagha, Ifeanyi C

    2015-01-01

    Achromobacter xylosoxidans is an aerobic, nonfermenting gram-negative rod and described as a waterborne bacterium since it habits aquatic environments ubiquitously. It has frequently been isolated from aquatic surroundings in the hospital and from various human body sites. Although occasionally considered a non-pathogen, A. xylosoxidans has been associated with outbreaks of nosocomial infection due to contaminated fluids. Moreover, a wide variety of infectious etiologies due to A. xylosoxidans has been reported primarily in immunocompromised individuals. Heightened awareness of this bacterium and associated clinical importance is warranted for clinicians since its broad disease spectrum in humans and frequent multi-drug resistance may result in an increased mortality rate. In this report, we describe a case of osteomyelitis caused by A. xylosoxidans in a patient with a history of diabetes mellitus.

  4. Multifocal bacterial osteomyelitis in a renal allograft recipient following urosepsis.

    Science.gov (United States)

    Valson, A T; David, V G; Balaji, V; John, G T

    2014-05-01

    Non-tubercular bacterial osteomyelitis is a rare infection. We report on a renal allograft recipient with osteomyelitis complicating urosepsis, manifesting as a multifocal infection poorly responsive to appropriate antibiotics and surgical intervention and culminating in graft loss.

  5. Antimicrobial peptides on calcium phosphate-coated titanium for the prevention of implant-associated infections

    DEFF Research Database (Denmark)

    Kazemzadeh-Narbat, Mehdi; Kindrachuk, Jason; Duan, Ke;

    2010-01-01

    Prevention of implant-associated infections has been one of the main challenges in orthopaedic surgery. This challenge is further complicated by the concern over the development of antibiotic resistance as a result of using traditional antibiotics for infection prophylaxis. The objective of this ...

  6. Imaging in osteomyelitis: Special features in childhood; Bildgebung bei Osteomyelitis: Besonderheiten im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Wandl-Vergesslich, K.A. [UOG MR-Einrichtung, Univ. Wien (Austria); Breitenseher, M. [UOG MR-Einrichtung, Univ. Wien (Austria); Fotter, R. [Universitaetsklinik fuer Radiologie und Zentralroentgeninstitut, Graz (Austria)

    1996-10-01

    The prognosis of acute hematogenous osteomyelitis in children ist mainly influenced by early diagnosis and prompt initiation of antibiotic and surgical therapy. In this age group, two forms of manifestation are differentiated: Osteomyelitis in infants up to 18 months and juvenile osteomyelitis until the closure of the epiphyseal plate. Osteomyelitis in infants is often accompanied by septic arthritis of the adjacent joint. In juvenile osteomyelitis, the disease is mostly confined to the metaphysis. Plain films and ultrasonography represent the basic imaging modalities. Depending on the age of the child, the clinical course of the disease and the availability of the various methods, MRI and multiphase bone scintigraphy can be performed for further imaging. CT is of only limited value and should only be used for special cases concerning chronic osteomyelitis. (orig.) [Deutsch] Die fruehzeitige Diagnose und das prompte Einsetzen der antibiotischen und chirurgischen Therapie sind fuer die Prognose der akuten hematogenen Osteomyelitis im Kindesalter von entscheidender Bedeutung. In dieser Altersgruppe werden 2 Manifestationsformen unterschieden. Die vor Beendigung des 18. Lebensmonats auftretende Saeuglingsosteomyelitis und die danach bis zum Schluss der Epiphysenfuge in Erscheinung tretende juvenile Form. Bei der Saeuglingsosteomyelitis kommt es in vielen Faellen zu einem Befall des benachbarten Gelenks, bei der juvenilen Osteomyelitis bleibt der primaere Befall fast immer auf die Metaphyse beschraenkt. Die Eckpfeiler der Bildgebung stellen das Nativroentgen und die Ultraschalluntersuchung dar. Je nach Alter des Kindes, klinischem Verlauf und Verfuegbarkeit der Methoden stehen MRT und die Dreiphasenknochenszintigraphie als weiterfuehrende Untersuchungsmethoden zur Verfuegung. Die CT hat begrenzte Aussagekraft und sollte nur besonderen klinischen Fragestellungen im Rahmen einer chronischen Osteomyelitis vorbehalten bleiben. (orig.)

  7. Reservoirs of Non-baumannii Acinetobacter Species.

    Science.gov (United States)

    Al Atrouni, Ahmad; Joly-Guillou, Marie-Laure; Hamze, Monzer; Kempf, Marie

    2016-01-01

    Acinetobacter spp. are ubiquitous gram negative and non-fermenting coccobacilli that have the ability to occupy several ecological niches including environment, animals and human. Among the different species, Acinetobacter baumannii has evolved as global pathogen causing wide range of infection. Since the implementation of molecular techniques, the habitat and the role of non-baumannii Acinetobacter in human infection have been elucidated. In addition, several new species have been described. In the present review, we summarize the recent data about the natural reservoir of non-baumannii Acinetobacter including the novel species that have been described for the first time from environmental sources and reported during the last years.

  8. Reservoirs of non-baumannii Acinetobacter species

    Directory of Open Access Journals (Sweden)

    Ahmad eAl Atrouni

    2016-02-01

    Full Text Available Acinetobacter spp are ubiquitous gram negative and non fermenting coccobacilli that have the ability to occupy several ecological niches including environment, animals and human. Among the different species, Acinetobacter baumannii has evolved as global pathogen causing wide range of infection. Since the implementation of molecular techniques, the habitat and the role of non baumannii Acinetobacter in human infection have been elucidated. In addition, several new species have been described. In the present review, we summarize the recent data about the natural reservoir of non-baumannii Acinetobacter including the novel species that have been described for the first time from environmental sources and reported during the last years.

  9. Conservative treatment in a patient with diabetic osteomyelitis

    DEFF Research Database (Denmark)

    Jeppesen, Sune Møller; Frokjaer, J.; Yderstraede, K.

    2015-01-01

    Diabetic foot ulcers are commonly complicated by bone involvement and osteomyelitis. Diagnosing diabetic osteomyelitis can be problematic. However, positive findings at clinical examination and X-ray may set the diagnosis. Recent guidelines suggest that selected cases of diabetic osteomyelitis can...... be treated conservatively with antibiotics. We report on the successful treatment of a 52-year-old man with diabetes with osteomyelitis in the distal phalanx of a toe. On X-ray, the affected phalanx appeared completely eroded. However, regeneration of the bone tissue was observed following outpatient...... treatment with antibiotics. We therefore encourage doctors to provide conservative treatment for selected cases of diabetic osteomyelitis....

  10. Aspergillus vertebral osteomyelitis in immunocompetent patients

    Directory of Open Access Journals (Sweden)

    Somika Sethi

    2012-01-01

    Full Text Available Fungal infections are one of the important cause of morbidity and mortality in immunocompromised patients. Aspergillus vertebral osteomyelitis is extremely rare. We report two cases of aspergillus vertebral osteomyelitis in immunocompetent men in the absence of an underlying disorder. The clinical and radiological findings were suggestive of Pott′s spine. The absolute CD4, CD8 counts and their ratio were normal. The HIV status was negative in both patients. Both patients underwent surgical decompression. The histopathology of tissue obtained were suggestive of aspergillus osteomyelitis. One patient had antifungal treatment for 3 months and was doing well at 1 year followup, whereas other patient did not turnup after 2 months.

  11. Recommendations for the treatment of osteomyelitis.

    Science.gov (United States)

    Lima, Ana Lucia L; Oliveira, Priscila R; Carvalho, Vladimir C; Cimerman, Sergio; Savio, Eduardo

    2014-01-01

    With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. After a careful literature review carried out by a multiprofessional team, some conclusions were made in order to guide medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and reducing the social costs of this disease. Acute and chronic osteomyelitis are discussed, with presentation of the general epidemiological concepts and the commonly used classification systems. The main guidelines for the clinical, laboratory and imaging diagnosis of infections are discussed, as well as the guidelines for surgical and antimicrobial treatments, and the role of hyperbaric oxygen as adjuvant therapy.

  12. Kingella kingae osteomyelitis of the clavicle.

    Science.gov (United States)

    Rotbart, H A; Gelfand, W M; Glode, M P

    1984-08-01

    Kingella kingae is the most recent addition to the list of etiologic agents causing osteomyelitis and septic arthritis in previously well children. A case is presented of a child with K. kingae osteomyelitis of the clavicle--an uncommon site of infection due to any organism. In the hope of facilitating the detection and treatment of this increasingly recognized pathogen, a brief discussion of its microbiologic characteristics and a summary of the patients reported to date with bone and joint infections due to this organism are included. To our knowledge, this is the first discussion of K. kingae in the orthopedic literature.

  13. Recurrent chronic suppurative osteomyelitis of the mandible

    Directory of Open Access Journals (Sweden)

    Rajkumar G

    2010-01-01

    Full Text Available Osteomyelitis of the maxillofacial skeleton is a rare condition in recent times. The combination of antibiotic therapy and surgical debridement is effective in the treatment of chronic suppurative osteomyelitis (CSO. This case report describes the successful surgical treatment of CSO of the mandible in an 18-year-old adult. Treatment included a pre-surgical course of antibiotics followed by sequestrectomy, resection of the coronoid process and removal of the pathologically fractured condylar process of the left side of the mandible. On post-operative clinical review at 1 week, the extra oral draining sinus healed with improved mouth opening.

  14. Ceftobiprole: First Reported Experience in Osteomyelitis

    Directory of Open Access Journals (Sweden)

    A MacDonald

    2010-01-01

    Full Text Available A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with local surgery. The present report is the first to administer intravenous ceftobiprole medocaril to a patient with methicillin-resistant S aureus-associated septic arthritis and osteomyelitis.

  15. Ciprofloxacin resistant osteomyelitis following typhoid fever

    OpenAIRE

    Ayeni, Itunuayo V; Calver, Graeme

    2012-01-01

    Salmonella typi is a rare cause of chronic osteomyelitis in a non-sickle cell patient. The authors report the case of a 25-year-old gentleman with a history of typhoid fever and an infected skin nodule on his left forearm 5 years prior to the diagnosis. He was referred to our orthopaedic colleagues with chronic osteomyelitis and underwent debridement of the bone for which samples grew Salmonella typhi. He was commenced on intravenous ceftriaxone 2 g once daily for 6 weeks followed by oral azi...

  16. Ceftobiprole: First reported experience in osteomyelitis.

    Science.gov (United States)

    Macdonald, A; Dow, G

    2010-01-01

    A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with local surgery. The present report is the first to administer intravenous ceftobiprole medocaril to a patient with methicillin-resistant S aureus-associated septic arthritis and osteomyelitis.

  17. Nanobiotechnology Perspectives on Prevention and Treatment of Ortho-paedic Implant Associated Infection.

    Science.gov (United States)

    Borse, Vivek; Pawar, Vaishali; Shetty, Gautam; Mullaji, Arun; Srivastava, Rohit

    2016-01-01

    Implants are an inevitable part of orthopaedic surgery. However, implant associated infection remains a major challenge for orthopaedic surgeons and researchers. This review focuses on current options available for prevention of implant associated infection, their drawbacks and future promising applications of nanotechnology-based approaches. Nanobiotechnology has shown remarkable progress in recent years especially in biomaterials, diagnostics, and drug delivery system. Although several applications of nanobiotechnology in orthopaedics have been described, few have elaborated their role in the prevention of implant related infection in orthopaedics. Novel "smart" drug delivery systems that release antibiotics locally in response to stimuli such as pH, temperature, enzymes or antigens; implant surface modification on a nanoscale to inhibit bacterial adhesion and propagation at the surgical site and biological approaches such as gene therapy to neutralize bacterial virulence and biomolecules to inhibit the quorum sensing adhesion of bacteria and disruption of biofilms can be used effectively to prevent orthopaedic implant related bacterial infection.

  18. Reservoirs of Non-baumannii Acinetobacter Species

    OpenAIRE

    Ahmad eAl Atrouni; Monzer eHamze; Marie-Laure eJoly-Guillou; Marie eKEMPF

    2016-01-01

    Acinetobacter spp. are ubiquitous gram negative and non-fermenting coccobacilli that have the ability to occupy several ecological niches including environment, animals and human. Among the different species, Acinetobacter baumannii has evolved as global pathogen causing wide range of infection. Since the implementation of molecular techniques, the habitat and the role of non-baumannii Acinetobacter in human infection have been elucidated. In addition, several new species have been described....

  19. Acinetobacter baumannii: evolution of a global pathogen.

    Science.gov (United States)

    Antunes, Luísa C S; Visca, Paolo; Towner, Kevin J

    2014-08-01

    Acinetobacter baumannii is an opportunistic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in hospitals worldwide. This human pathogen is responsible for a vast array of infections, of which ventilator-associated pneumonia and bloodstream infections are the most common, and mortality rates can reach 35%. Community-acquired infections have also been reported, but few strains have been recovered from environmental sources and infection reservoirs external to the hospital have not been identified. The majority of A. baumannii infections are caused by two main population clones with worldwide distribution. Infection outbreaks are often associated with multidrug resistance, including the recent emergence of strains resistant to all available antibiotics. Nevertheless, A. baumannii virulence traits and pathogenic potential have mostly remained elusive. The recent expansion of A. baumannii sequenced genomes has permitted the development of large-array phylogenomic and phenotypic analyses, which can offer valuable insights into the evolution and adaptation of A. baumannii as a human pathogen. This review summarises these recent advances, with particular focus on A. baumannii evolutionary and genomic aspects, and proposes new avenues of research.

  20. Iron and Acinetobacter baumannii Biofilm Formation

    Directory of Open Access Journals (Sweden)

    Valentina Gentile

    2014-08-01

    Full Text Available Acinetobacter baumannii is an emerging nosocomial pathogen, responsible for infection outbreaks worldwide. The pathogenicity of this bacterium is mainly due to its multidrug-resistance and ability to form biofilm on abiotic surfaces, which facilitate long-term persistence in the hospital setting. Given the crucial role of iron in A. baumannii nutrition and pathogenicity, iron metabolism has been considered as a possible target for chelation-based antibacterial chemotherapy. In this study, we investigated the effect of iron restriction on A. baumannii growth and biofilm formation using different iron chelators and culture conditions. We report substantial inter-strain variability and growth medium-dependence for biofilm formation by A. baumannii isolates from veterinary and clinical sources. Neither planktonic nor biofilm growth of A. baumannii was affected by exogenous chelators. Biofilm formation was either stimulated by iron or not responsive to iron in the majority of isolates tested, indicating that iron starvation is not sensed as an overall biofilm-inducing stimulus by A. baumannii. The impressive iron withholding capacity of this bacterium should be taken into account for future development of chelation-based antimicrobial and anti-biofilm therapies.

  1. Salmonella osteomyelitis by sickle cell anemia

    Energy Technology Data Exchange (ETDEWEB)

    Rausch, H.; Tran, V.T.; Boeckmann, U.

    1985-10-01

    Case report of a 28 year old black sickle cell anemia patient with salmonella osteomyelitis of the radius. Aside from sickle cell anemia patients this skeletal complication of enteric salmonellosis is an extreme rarity. Description of the typical roentgenological features includes intracortical fissures and sequestration.

  2. Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome

    NARCIS (Netherlands)

    Kempen, D. H R; van Dijk, M.; Hoepelman, A. I M; Oner, F. C.; Verlaan, J. J.

    2015-01-01

    Purpose: To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. Methods: A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin fo

  3. Antimicrobial peptides : Experimental prevention of osteomyelitis

    NARCIS (Netherlands)

    Stallmann, H.P.

    2007-01-01

    The first chapter introduces the main concepts of this manuscript: osteomyelitis (bone infection), bacterial resistance and antimicrobial peptides (AMPs). As part of a solution to the first two problems, AMPs were investigated for the experimental prevention of infection. The first chapter introduc

  4. Amebic osteomyelitis in an immunocompromised patient.

    Science.gov (United States)

    Breland, Matthew; Beckmann, Nicholas

    2016-09-01

    Acanthamoeba spp. are pathogenic protozoa that are uncommonly encountered. They tend to infect immunocompromised patients, most often causing cutaneous lesions and in some instances granulomatous amebic encephalitis, as well as rare instances of dissemination to other organs. We present a case of amebic osteomyelitis of the fibula in a patient with rejection of a transplanted kidney who was chronically immune-suppressed.

  5. Osteomyelitis in burn patients requiring skeletal fixation

    NARCIS (Netherlands)

    Barret, JP; Desai, MH; Herndon, DN

    2000-01-01

    Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.

  6. The Macrophage Inflammatory Proteins MIP1α (CCL3 and MIP2α (CXCL2 in Implant-Associated Osteomyelitis: Linking Inflammation to Bone Degradation

    Directory of Open Access Journals (Sweden)

    Ulrike Dapunt

    2014-01-01

    Full Text Available Bacterial infections of bones remain a serious complication of endoprosthetic surgery. These infections are difficult to treat, because many bacterial species form biofilms on implants, which are relatively resistant towards antibiotics. Bacterial biofilms elicit a progressive local inflammatory response, resulting in tissue damage and bone degradation. In the majority of patients, replacement of the prosthesis is required. To address the question of how the local inflammatory response is linked to bone degradation, tissue samples were taken during surgery and gene expression of the macrophage inflammatory proteins MIP1α (CCL3 and MIP2α (CXCL2 was assessed by quantitative RT-PCR. MIPs were expressed predominantly at osteolytic sites, in close correlation with CD14 which was used as marker for monocytes/macrophages. Colocalisation of MIPs with monocytic cells could be confirmed by histology. In vitro experiments revealed that, aside from monocytic cells, also osteoblasts were capable of MIP production when stimulated with bacteria; moreover, CCL3 induced the differentiation of monocytes to osteoclasts. In conclusion, the multifunctional chemokines CCL3 and CXCL2 are produced locally in response to bacterial infection of bones. In addition to their well described chemokine activity, these cytokines can induce generation of bone resorbing osteoclasts, thus providing a link between bacterial infection and osteolysis.

  7. Proteomic insights into Acinetobacter baumannii drug resistance and pathogenesis.

    Science.gov (United States)

    Long, Quanxin; Huang, Changwu; Liao, Pu; Xie, Jianping

    2013-01-01

    Acinetobacter baumannii is an important opportunist pathogen, due to severe antibiotic resistance and nosocomial infection. The epidemiology and antibiotic resistance of A.baumannii have been extensively reviewed, but the pathogenesis and virulence remain unclear. Proteomics analysis has been applied to study the mechanism of drug resistance, biofilm, micronutrient acquisition, and the extracellular compartment. This review summarizes applications of proteomics in A. baumannii, aiming to summarize novel insights into the mechanism of A. baumannii pathogenesis and drug resistance.

  8. Carbapenem-resistant Acinetobacter baumannii: epidemiology, surveillance and management.

    Science.gov (United States)

    Pogue, Jason M; Mann, Tal; Barber, Katie E; Kaye, Keith S

    2013-04-01

    Carbapenem-resistant Acinetobacter baumannii pose a significant threat to hospitalized patients, as therapeutic options are scarse. Alarmingly, rates of carbapenem-resistance in A. baumannii are on the rise and are slowly becoming a routine phenotype for this organism. This review focuses on infection control strategies for identification and control of A. baumannii, as well the available therapeutic options.

  9. A Pathogenic Potential of Acinetobacter baumannii-Derived Membrane Vesicles

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    Jong Suk Jin

    2011-12-01

    Full Text Available Acinetobacter baumannii secretes outer membrane vesicles (OMVs. A. baumannii OMVs deliver many virulence factors to host cells and then induce cytotoxicity and innate immune response. OMVs secreted from bacteria contribute directly to host pathology during A. baumannii infection.

  10. Radionuclide imaging in the evaluation of osteomyelitis and septic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, E.E.; Haynie, T.P.; Podoloff, D.A.; Lowry, P.A.; Harle, T.S. (Univ. of Texas M.D. Anderson Hospital, Houston (USA))

    1989-01-01

    Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In-111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis. 83 references.

  11. Non-contiguous multifocal vertebral osteomyelitis caused by Serratia marcescens.

    Science.gov (United States)

    Lau, Jen Xin; Li, Jordan Yuanzhi; Yong, Tuck Yean

    2015-03-01

    Serratia marcescens is a common nosocomial infection but a rare cause of osteomyelitis and more so of vertebral osteomyelitis. Vertebral osteomyelitis caused by this organism has been reported in few studies. We report a case of S. marcescens vertebral discitis and osteomyelitis affecting multiple non-contiguous vertebras. Although Staphylococcus aureus is the most common cause of vertebral osteomyelitis, rare causes, such as S. marcescens, need to be considered, especially when risk factors such as intravenous heroin use, post-spinal surgery and immunosuppression are present. Therefore, blood culture and where necessary biopsy of the infected region should be undertaken to establish the causative organism and determine appropriate antibiotic susceptibility. Prompt diagnosis of S. marcescens vertebral osteomyelitis followed by the appropriate treatment can achieve successful outcomes.

  12. Diode laser osteoperforation and its application to osteomyelitis treatment

    Science.gov (United States)

    Privalov, Valeriy A.; Krochek, Igor V.; Lappa, Alexander V.

    2001-10-01

    Laser osteoperforation, previously studied in experiment in rabbits at treatment for acute purulent osteomyelitis (Privalov V. et.al., SPIE Proc., v.3565., pp. 72-79), was applied in clinic to 36 patients with chronic purulent osteomyelitis and to 6 patients (children) with acute haematogenic osteomyelitis. Diode lasers of 805 and 980 nm wavelength were used. There was achieved full recovery in all acute cases, and stable remission in chronic cases during all the observation period (1 - 2.5 years).

  13. Candidal Vertebral Osteomyelitis in the Midst of Renal Disorders

    Science.gov (United States)

    Kumar, Anil; Rao, Srivatsa Nagaraja; Kumar, Krishna; Karim, Shamsul

    2016-01-01

    Vertebral osteomyelitis also known as discitis/pyogenic spondylitis refers to inflammation of the vertebral disc space. It is commonly seen in men and adults more than 50 years of age. Fungal osteomyelitis is a rare scenario compared to its bacterial counterpart. Spinal epidural abscess is a dangerous complication associated with vertebral osteomyelitis. Here, we report two cases of vertebral osteomyelitis caused by Candida tropicalis in patients with renal disorders (stage 5 chronic kidney disease and nephropathy). One of the case discussed here presented with spinal epidural abscess. Both the patients were started on antifungal therapy. One patient responded to treatment while the other was lost to follow up. PMID:27190806

  14. Chronic recurrent multifocal osteomyelitis: a rare skeletal disorder.

    Science.gov (United States)

    Aygun, Deniz; Barut, Kenan; Camcioglu, Yildiz; Kasapcopur, Ozgur

    2015-08-25

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare non-infectious inflammatory bone disease of unknown aetiology. CRMO mainly affects the metaphyses of long bones and spine in children and young adolescents. It presents with recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures of lesions are sterile and it is unresponsive to antibiotic therapy. We report a case of a 3-year-old boy diagnosed with CRMO, who was initially treated for bacterial osteomyelitis, and received prolonged antibiotic therapy for chronic pain, and swelling of mandible and ulna. CRMO should be kept in mind in the differential diagnosis of chronic bone pain and osteomyelitis unresponsive to antibiotic treatment.

  15. Amebic osteomyelitis in an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    Matthew Breland, MD

    2016-09-01

    Full Text Available Acanthamoeba spp. are pathogenic protozoa that are uncommonly encountered. They tend to infect immunocompromised patients, most often causing cutaneous lesions and in some instances granulomatous amebic encephalitis, as well as rare instances of dissemination to other organs. We present a case of amebic osteomyelitis of the fibula in a patient with rejection of a transplanted kidney who was chronically immune-suppressed.

  16. Ceftobiprole: First Reported Experience in Osteomyelitis

    OpenAIRE

    2010-01-01

    A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with...

  17. Ciprofloxacin resistant osteomyelitis following typhoid fever.

    Science.gov (United States)

    Ayeni, Itunuayo V; Calver, Graeme

    2012-07-13

    Salmonella typi is a rare cause of chronic osteomyelitis in a non-sickle cell patient. The authors report the case of a 25-year-old gentleman with a history of typhoid fever and an infected skin nodule on his left forearm 5 years prior to the diagnosis. He was referred to our orthopaedic colleagues with chronic osteomyelitis and underwent debridement of the bone for which samples grew Salmonella typhi. He was commenced on intravenous ceftriaxone 2 g once daily for 6 weeks followed by oral azithromycin 500 mg once daily for a further 6 weeks. The purpose of this case report is to consider the possible mode for antibiotic resistance. In this patient, the authors believe that partial treatment of the typhoid fever 5 years prior to diagnosis of osteomyelitis enabled antibiotic resistance to ciprofloxacin. Furthermore, the authors believe that the infected nodule was the result of direct inoculation with the Salmonella organism which then acted as a focus for further infections.

  18. Optimal management of chronic osteomyelitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Pande KC

    2015-08-01

    Full Text Available Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. Keywords: osteomyelitis, infection, biofilm, bone, therapy, treatment

  19. Extracorporeal Shock Wave Therapy could be a Potential Adjuvant Treatment for Orthopaedic Implant-associated Infections

    Directory of Open Access Journals (Sweden)

    Xiao-feng Chen

    2013-07-01

    Full Text Available Over the past half-century, biomaterials have been used in orthopaedic surgery world widely, but orthopaedic implant-associated infections (OIAIs are still a puzzle for orthopaedic surgeons, which may result in prolonged hospitalisation, poor functional status and high costs. The presence of implants increases the risk of microbial infection; moreover, the formation of bacterial biofilm leads to a higher resistance to antibiotics and local immune response. In such cases, conventional systemic delivery of drugs seems to be fairly inefficient and out-dated. Owing to this, debridement and/or removing the implant always become the only solution. Hence, it needs a simple, minimally invasive and effective therapy to eradicate the problem. There are abundant evidences showing that extracorporeal shock wave therapy (ESWT has favourable effects on stimulating callus formation, inducing angiogenesis, promoting osteogenesis and relieving pain. Studies also indicated that ESWs have a significant bactericidal effect on bacterial strains of bone- and implant-associated infections. Therefore, a hypothesis proposed herein is that ESWT may well be an effective adjuvant treatment for OIAI by controlling infection, inducing bone regeneration and promoting re-osseointegration.

  20. Osteomyelitis associated with Nocardiopsis composta in a dog.

    Science.gov (United States)

    Salas, Elisa N; Royal, Debra; Kurz, Lance; Loy, J Dustin

    2015-05-01

    We report the first detection of Nocardiopsis composta in association with osteomyelitis in a young male miniature Australian shepherd dog. Findings included suppurative osteomyelitis containing intralesional Fite's acid fast bacilli, aerobic culture of branching Gram-positive rods, and positive identification via phenotypic analysis and 16S rDNA sequencing.

  1. [Spiral computed tomography in the diagnosis of limb osteomyelitis].

    Science.gov (United States)

    Vasil'ev, A Iu; Bulanova, T V; Onishchenko, M P

    2003-01-01

    The results of radiation studies in 121 patients of different age (4 to 75 years) examined for limb osteomyelitis are analyzed. All the patients underwent routine X-ray study and computed tomography (CT), 26 patients had X-ray fistulography; 8, linear tomography; 10, CT fistulography; 6, scintigraphy, and 15, ultrasound study. Acute hematogenous osteomyelitis (AHO), chronic hematogenous osteomyelitis (CHO), and atypical (here Garre's sclerosing osteomyelitis and Brodie's abscess) osteomyelitis were ascertained in 10.6, 26.4, and 10.1% of cases, respectively. Posttraumatic osteomyelitis was diagnosed in almost 50% of the patients. CT defined the phase of chronic limb osteomyelitis. Spiral CT has proven to be the most effective technique for diagnosing limb osteomyelitis as compared with routine X-ray study: the accuracy of X-ray study was 81.8%, its sensitivity, 84.9%, and specificity, 60.0% and those of computed tomography were 96.7, 99.1, and 80.0%, respectively.

  2. Screening for Osteomyelitis Using Thermography in Patients with Diabetic Foot

    Directory of Open Access Journals (Sweden)

    Makoto Oe

    2013-01-01

    Full Text Available One of the most serious complications of diabetic foot (DF is osteomyelitis, and early detection is important. To assess the validity of thermography to screen for osteomyelitis, we investigated thermographic findings in patients with both DF and osteomyelitis. The subjects were 18 diabetic patients with 20 occurrences of DF who visited a dermatology department at a hospital in Tokyo and underwent evaluation by magnetic resonance imaging (MRI and thermography between June 2010 and July 2012. Osteomyelitis was identified by MRI. Thermographs were taken of the wounds and legs after bed rest of more than 15 minutes. Two wound management researchers evaluated the range of increased skin temperature. There were three types of distribution of increased skin temperature: the periwound, ankle, and knee patterns. Fisher’s exact test revealed that the ankle pattern was significantly more common in the group with osteomyelitis than in the group without osteomyelitis (P=0.011. The positive predictive value was 100%, and the negative predictive value was 71.4%. Our results suggest that an area of increased skin temperature extending to the ankle can be a sign of osteomyelitis. Thermography might therefore be useful for screening for osteomyelitis in patients with DF.

  3. [Carbapenem-resistant Acinetobacter baumannii strains].

    Science.gov (United States)

    Bogiel, Tomasz; Kwiecińska-Piróg, Joanna; Jachna-Sawicka, Katarzyna; Gospodarek, Eugenia

    2010-01-01

    A. baumannii rods are opportunistic pathogens responsible generally for nosocomial infections. Resistance to carbapenems, observed among them, is a serious threat due to ability to be transmitted between bacterial species. The aim of our study was to evaluate the frequency of isolation and susceptibility to antibiotics of resistant to imipenem and/or meropenem A. baumannii strains isolated between 2007 and 2009 from patients of University Hospital of dr A. Jurasz Collegium Medicum of L. Rydygier in Bydgoszcz Nicolaus Copernicus University in Toruń. Study shows increasing frequency of isolation that type of strains from 4 in 2007 to 95 in 2008 and 67 in 2009. Percentage of imipenem-resistant isolates raised to 27.6% in 2008 and 31.0% in 2009. Meropenem-resistant A. baumannii isolates frequency changed from 2.1% in 2007 to 31.2% and 34.6%, in 2008 and 2009, respectively. The majority of strains were obtained from patients of the Intensive Care Units and surgery clinics. Examined A. baumannii strains were generally isolated from bronchoalveolar lavage (25.3%) and wound (18.1%) or throat (12.0%) swabs samples. The isolates demonstrated full resistance to norfloxacin, ciprofloxacin, and chloramphenicol. Ampicillin/sulbactam (24.8%), tobramycin (8.1%) and colistin (1.5%) presented the highest in vitro activity against isolated strains.

  4. Antimicrobial resistance and clonality in Acinetobacter baumannii

    NARCIS (Netherlands)

    Nemec, Alexandr

    2009-01-01

    The aim of this thesis was to obtain insight into the epidemiology and molecular basis of multidrug resistance of Acinetobacter baumannii at the population level. To this aim a number of studies were performed on strains mainly from the Czech Republic (CR) which have shown in particular that (i) the

  5. Electrospun vancomycin-loaded coating on titanium implants for the prevention of implant-associated infections

    Directory of Open Access Journals (Sweden)

    Zhang L

    2014-06-01

    Full Text Available Li Zhang,* Junwei Yan,* Zhaowei Yin, Cheng Tang, Yang Guo, Dong Li, Bo Wei, Yan Xu, Qiangrong Gu, Liming Wang Orthopedic Laboratory of Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China *Both of these authors contributed equally to this work Abstract: The objectives of this work were to develop an antibiotic coating on the surface of a titanium plate to determine its antibacterial properties in vitro and in vivo. To prepare vancomycin-coated titanium implants, we adopted the electrospinning nanotechnique. The surface structure of the coating implants was observed using a scanning electron microscope. An elution method and a high-pressure liquid chromatography assay were used to characterize the release behavior of vancomycin from the coating. The antibacterial efficacy and the cytotoxicity of the coated titanium implants on osteoblasts were investigated in vitro. In addition, X-ray, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and pathological examination were performed to validate its antimicrobial efficacy in vivo. The antibiotic coating released 82.7% (approximately 528.2 µg of total vancomycin loading in the coating in vitro. The release behavior of vancomycin from nanofiber coatings exhibited a biphasic release pattern with an initial burst on day 1, followed by a slow and controlled release over 28 days. There was no cytotoxicity observed in vitro for the vancomycin-loaded coating. The vancomycin-coated titanium implants were active in treating implant-associated infection in vivo. Thus, vancomycin-coated titanium implants may be a promising approach to prevent and treat implant-associated infections. Keywords: electrospinning, vancomycin, implant, infection, coating, nanofibers

  6. Quantitative proteomics to study carbapenem resistance in Acinetobacter baumannii.

    Science.gov (United States)

    Tiwari, Vishvanath; Tiwari, Monalisa

    2014-01-01

    Acinetobacter baumannii is an opportunistic pathogen causing pneumonia, respiratory infections and urinary tract infections. The prevalence of this lethal pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source. Moreover it resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. Resistance against carbapenem has emerged in Acinetobacter baumannii which can create significant health problems and is responsible for high morbidity and mortality. With the development of quantitative proteomics, a considerable progress has been made in the study of carbapenem resistance of Acinetobacter baumannii. Recent updates showed that quantitative proteomics has now emerged as an important tool to understand the carbapenem resistance mechanism in Acinetobacter baumannii. Present review also highlights the complementary nature of different quantitative proteomic methods used to study carbapenem resistance and suggests to combine multiple proteomic methods for understanding the response to antibiotics by Acinetobacter baumannii.

  7. Quantitative Proteomics to study Carbapenem Resistance in Acinetobacter baumannii

    Directory of Open Access Journals (Sweden)

    Vishvanath eTiwari

    2014-09-01

    Full Text Available Acinetobacter baumannii is an opportunistic pathogen causing pneumonia, respiratory infections and urinary tract infections. The prevalence of this lethal pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source. Moreover it resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. Resistance against carbapenem has emerged in Acinetobacter baumannii which can create significant health problems and is responsible for high morbidity & mortality. With the development of quantitative proteomics, a considerable progress has been made in the study of carbapenem resistance of Acinetobacter baumannii. Recent updates showed that quantitative proteomics has now emerged as an important tool to understand the carbapenem resistance mechanism in Acinetobacter baumannii. Present review also highlights the complementary nature of different quantitative proteomic methods used to study carbapenem resistance and suggests to combine multiple proteomic methods for understanding the response to antibiotics by Acinetobacter baumannii.

  8. Osteomyelitis: an overview of antimicrobial therapy

    Directory of Open Access Journals (Sweden)

    Diana Gomes

    2013-03-01

    Full Text Available Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high doses of antibiotics (AB by means of endovenous and oral routes and should take a period of at least 6 weeks. Local drug delivery systems, using non-biodegradable (polymethylmethacrylate or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. These systems allow the local delivery of AB in situ with bactericidal concentrations for long periods of time and without the toxicity associated with other means of administration. This review examines the most recent literature evidence on the causes, pathogeneses and pharmacological treatment of osteomyelitis. The study methodology consisted of a literature review in Google Scholar, Science Direct, Pubmed, Springer link, B-on. Papers from 1979 till present were reviewed and evaluated.A osteomielite é um processo inflamatório do tecido ósseo, de origem infecciosa, que resulta em destruição inflamatória, necrose e formação de novo osso. Pode aparecer em qualquer idade, afetar qualquer osso e tornar-se uma doença crônica com morbidade persistente. Apesar dos progressos na quimioterapia infecciosa, o tratamento da osteomielite é caro e difícil, em particular quando associada à presença de biofilmes bacterianos

  9. Quantitative Proteomics to study Carbapenem Resistance in Acinetobacter baumannii

    OpenAIRE

    Vishvanath eTiwari; Monalisa eTiwari

    2014-01-01

    Acinetobacter baumannii is an opportunistic pathogen causing pneumonia, respiratory infections and urinary tract infections. The prevalence of this lethal pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source. Moreover it resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. Resistance against carbapenem has emerged in Acinetobacter baumannii which can create signific...

  10. Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia

    OpenAIRE

    Chen, Chang-Hua; Wu, Shun-Sheng; Huang, Chieh-Chen

    2013-01-01

    Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Esch...

  11. Quantitative proteomics to study carbapenem resistance in Acinetobacter baumannii

    OpenAIRE

    Tiwari, Vishvanath; Tiwari, Monalisa

    2014-01-01

    Acinetobacter baumannii is an opportunistic pathogen causing pneumonia, respiratory infections and urinary tract infections. The prevalence of this lethal pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source. Moreover it resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. Resistance against carbapenem has emerged in Acinetobacter baumannii which can create signific...

  12. Case report: treatment of chronic osteomyelitis.

    Science.gov (United States)

    Wolfe, Cameron R

    2011-06-01

    Presented is a case of chronic methicillin-resistant Staphylococcus aureus osteomyelitis, which was unsuccessfully treated with multiple courses of debridement and potent antibiotic therapies. Amputation of the patient's lower limb was believed to be the only option remaining. A compassionate access program, with approval from the US Food and Drug Administration and the institutional review board, enabled the patient to undergo a course of treatment with oral fusidic acid (CEM-102). The patient tolerated the drug well, with no significant toxicities noted to date. His infection improved rapidly, his flap healed, he has returned to work part-time, and he continues to take daily suppressive doses of oral CEM-102.

  13. Bone Scintigraphic Findings in MRSA Osteomyelitis.

    Science.gov (United States)

    Cornejo, Patricia; Mandell, Gerald A

    2016-02-01

    Methicillin-resistant Staphylococcus aureus osteomyelitis is a severe form of infection characterized by multifocal or multiple segmental osseous involvement and subperiosteal abscess formation with increased frequency of extraosseous complications including pyomyositis, septic thrombus, and septic arthritis. Bone scan showed long segment and/or multifocal involvement in 4 of 5 patients with areas of abnormal increased and decreased uptake. The clinical presentations included limp and/or pain. Joint involvement was seen in 4 cases. Bone scan abnormalities correlated well with MRI findings of severe and extensive bone disease, abscess formation, muscle, as well as joint and soft tissue involvement.

  14. Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia.

    Science.gov (United States)

    Chen, Chang-Hua; Wu, Shun-Sheng; Huang, Chieh-Chen

    2013-05-14

    Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Escherichia coli, viridans streptococcus, and A. baumannii). After a literature review, we suggest that correct gastroendoscopy technique and skill in drainage procedures, as well as antibiotic prophylaxis, are of paramount importance in minimizing the risk of gastroendoscopy-associated bacteremia.

  15. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Henninger, B.; Glodny, B.; Rudisch, A.; Trieb, T.; Loizides, A.; Judmaier, W.; Schocke, M.F. [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Putzer, D. [Innsbruck Medical University, Department of Nuclear Medicine, Innsbruck (Austria)

    2013-08-15

    To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis. (orig.)

  16. [Osteomyelitis: a probable, uncommon etiology agent].

    Science.gov (United States)

    Cuoco, F; Borzani, I; Torcoletti, M; Beltrami, V; Petaccia, A; Corona, F

    2015-06-01

    The relation of infectious agents to arthritis is an area of great interest to the rheumatologist. Septic arthritis of bacterial origin accounts for approximately 6.5% of all childhood arthritides. Septic arthritis usually results from haematogenous spread from a focus of infection elsewhere in the body, but also by direct extension of an infection from overlying soft tissues or bone or traumatic invasion of the joint. As a result, if a focus of underlying osteomyelitis breaks throught the metaphysis, it may enter the joint and result in septic arthritis. Systemic signs of illness are fever, severe bone pain, and tenderness with or without local swelling. A wide range of microorganism can cause septic arthritis in children; Staphylococcus aureus and nongroup A and B streptococci are most common overall. However, different organisms are more common at some ages and in certain circumstances. Kingella kingae is an emerging pathogen in young children under 4 years of age. The clinical presentation of K. kingae invasive infection is often subtle and may be associated to mild to moderate biologic inflammatory responses. Affected children often have few signs and symptoms of osteoarticular infections. Early MRI is useful in differentiating K kingae from Gram-positive cocci in osteoarticular infections. Cartilaginous involvement, modest soft tissue and bone reaction suggest K. kingae. It's very important to include K. kingae in differential diagnosis of osteoarticular infections in young children. We report an unusual case of osteomyelitis: clinical manifestations and MRI are suggestive for K kingae infection.

  17. Imaging osteomyelitis and the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Becker, W. (Gottingen Univ. (Germany). Dep. of Nuclear Medicine)

    1999-03-01

    The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with [sup 111]In-oxin or [sup 99m]Tc-HMPAO, antigranulocyte antibodies, [sup 99m]Tc/[sup 111]In-human immunoglobulin,[sup 67] Ga-citrate and [sup 99m]Tc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed.

  18. Imaging of chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Khanna, Geetika; Sato, Takashi S P; Ferguson, Polly

    2009-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis. Patients typically present with multifocal bone pain secondary to sterile osseous inflammation, and the disease has a relapsing and remitting course. The cause of CRMO remains unclear, although the results of several studies have suggested a genetic component. The typical imaging findings of CRMO include lytic and sclerotic lesions in the metaphyses of long bones and the medial clavicles. Other common sites of disease are the vertebral bodies, pelvis, ribs, and mandible. CRMO is often bilateral and multifocal at presentation. Owing to the lack of a diagnostic test, CRMO remains a diagnosis of exclusion. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Radiologists can be the first to suggest this diagnosis given its characteristic radiographic appearance and distribution of disease. Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO.

  19. Concentration of Sonication Fluid through Centrifugation Is Superior to Membrane Filtration for Microbial Diagnosis of Orthopedic Implant-Associated Infection.

    Science.gov (United States)

    Zitron, Renato; Wajsfeld, Tali; Klautau, Giselle Burlamaqui; da Silva, Cely Barreto; Nigro, Stanley; Mercadante, Marcelo Tomanik; Polesello, Giancarlo Cavalli; Cury, Ricardo de Paula Leite; Salles, Mauro Jose Costa

    2016-03-01

    Microbial identification of orthopedic implant-associated infections using sonication fluid (SF) submitted to a concentration step by membrane filtration (SMF) was compared with the standard centrifugation (SC) method. Among 33 retrieved infected implants, sonication identified microorganisms in 26 (78.8%). The sensitivity of SC was higher than that of SMF (78.8% versus 30.3%; P < 0.001).

  20. Osteomyelitis following extraction of lower third molar during pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Bin; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Kim, Mi Ja [Department of Dentistry, Hangang Sacred Heart Hospital, Hallym University, Seoul (Korea, Republic of)

    2008-09-15

    A 27-year-old female was referred to our hospital postpartum due to rapid aggravation of facial swelling. She was diagnosed with osteomyelitis on clinical, radiological, and histopathological examinations, but the possibility of malignancy was not excluded. Clinical signs and symptoms such as facial swelling and discomfort were improved with four months of antibiotics treatment. This is a case of an osteomyelitis progressed from infected extraction socket in a woman with physiological changes of pregnancy. Decreased immunological response, increased sex hormone and calcium regulatory hormones regulate the response of the bone infection. We report this case for helping the diagnosis of unusual form of osteomyelitis in pregnancy and postpartum.

  1. Periostitis ossificans (Garrè's osteomyelitis): An unusual case.

    Science.gov (United States)

    Singh, Deepesh; Subramaniam, Priya; Bhayya, Panduranga Deepak

    2015-01-01

    Garrè's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè's osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

  2. [Chronic recurrent multifocal osteomyelitis of the spine : Children and adolescent].

    Science.gov (United States)

    von der Höh, N H; Völker, A; Jeszenszky, D; Heyde, C-E

    2016-06-01

    Chronic non-bacterial osteomyelitis (CNO) in childhood and adolescence is a non-infectious autoinflammatory disease of the bone with partial involvement of adjacent joints and soft tissue. The etiology is unknown. The disease can occur singular or recurrent. Individual bones can be affected and multiple lesions can occur. Chronic recurrent multifocal osteomyelitis (CRMO) shows the whole picture of CNO. Accompanying but temporally independent of the bouts of osteomyelitis, some patients show manifestations in the skin, eyes, lungs and the gastrointestinal tract. The article gives an overview of the clinical manifestations, diagnostic procedures, and treatment options for CRMO involvement of the spine based on the current literature and our own cases.

  3. Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

    Science.gov (United States)

    Hibino, Naohito; Sairyo, Koichi; Yoshioka, Shinji; Yamano, Masahiro; Henmi, Tatsuhiko

    2014-01-01

    Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole. PMID:25215255

  4. Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

    Directory of Open Access Journals (Sweden)

    Shunichi Toki

    2014-01-01

    Full Text Available Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.

  5. Congenital multifocal osteomyelitis at 24 weeks' gestation

    Energy Technology Data Exchange (ETDEWEB)

    Raupp, Peter; Shubbar, Adil; Baichoo, Vijaymani; Samson, Gregory [Al Corniche Hospital, Department of Neonatology, P.O. Box 3788, Abu Dhabi (United Arab Emirates)

    2007-12-15

    We report an extremely rare case of congenital nonsyphilitic osteomyelitis in a very preterm infant, providing a unique illustration of the radiological appearances at birth, which may serve as a reference to facilitate diagnosis. (orig.)

  6. Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

    Directory of Open Access Journals (Sweden)

    Tamer Celakil

    2016-01-01

    Full Text Available Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction.

  7. Staphylococcus lugdunensis: A Rare Pathogen for Osteomyelitis of the Foot.

    Science.gov (United States)

    Kear, Shelby; Smith, Collin; Mirmiran, Roya; Hofinger, Diedre

    2016-01-01

    Staphylococcus lugdunensis is an aggressive gram-positive bacteria that can lead to devastating infections in humans. S. lugdunensis has been associated with rare cases of osteomyelitis of the vertebra, prosthetic implants, and endocarditis. Reports of this organism associated with osteomyelitis of the foot or ankle have been infrequent. We present a unique case of acute osteomyelitis of a foot caused by S. lugdunensis after a patient stepped on a thorn. Our case is unique, because the radiographic changes were noted within 4 days, despite normal plain films and magnetic resonance images on the day of admission. This finding suggests the aggressiveness and virulence of S. lugdunensis. In addition, we report the first case of foot osteomyelitis as a result of isolated S. lugdunensis that involved 2 distinct specimens with 2 different antibiotic sensitivity reports.

  8. Symphysis Pubis Osteomyelitis with Bilateral Adductor Muscles Abscess

    Directory of Open Access Journals (Sweden)

    Saad M. Alqahtani

    2014-01-01

    Full Text Available Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA, which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain.

  9. A Case of Pediatric Q Fever Osteomyelitis Managed Without Antibiotics.

    Science.gov (United States)

    Khatami, Ameneh; Sparks, Rebecca T; Marais, Ben J

    2015-12-01

    Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.

  10. Diabetic foot ulceration with osteomyelitis: the importance of early detection

    OpenAIRE

    Tranter, Jennifer; McIntosh, Caroline

    2008-01-01

    This case study explores the\\ud management of a chronic diabetic\\ud foot ulcer complicated by severe\\ud soft tissue infection (cellulitis) and\\ud bony infection (osteomyelitis) in a\\ud patient with type 2 diabetes.

  11. Characterization of Acinetobacter baumannii biofilm associated components

    Science.gov (United States)

    Brossard, Kari A.

    Acinetobacter baumannii is a Gram-negative aerobic coccobaccillus that is a major cause of nosocomial infections worldwide. Infected individuals may develop pneumonia, urinary tract, wound, and other infections that are associated with the use of indwelling medical devices such as catheters and mechanical ventilation. Treatment is difficult because many A. baumannii isolates have developed multi-drug resistance and the bacterium can persist on abiotic surfaces. Persistence and resistance may be due to formation of biofilms, which leads to long-term colonization, evasion of the host immune system and resistance to treatment with antibiotics and disinfectants. While biofilms are complex multifaceted structures, two bacterial components that have been shown to be important in formation and stability are exopolysaccharides (EPS) and the biofilm-associated protein (Bap). An EPS, poly-beta-1,6-N-acetylglucosamine, PNAG, has been described for E. coli and S. epidermidis. PNAG acts as an intercellular adhesin. Production of this adhesin is dependent on the pga/icaABCD locus. We have identified a homologous locus in A. baumannii 307-0294 that is involved in production of an exopolysaccharide, recognized by an anti-PNAG antibody. We hypothesized that the A. baumannii pgaABCD locus plays a role in biofilm formation, and protection against host innate defenses and disinfectants suggesting that PNAG is a possible virulence factor for the organism. The first aim of this thesis will define the pgaABCD locus. We have previously identified Bap, a protein with similarity to those described for S. aureus and we have demonstrated that this protein is involved in maintaining the stability of biofilms on glass. We hypothesized that A. baumannii Bap plays a role in persistence and pathogenesis and is regulated by quorum sensing. In our second aim we will examine the role of Bap in attachment and biofilm formation on medically relevant surfaces and also determine if Bap is involved in

  12. Primary tuberculous osteomyelitis of the mandible- A Rare Case Report-

    Directory of Open Access Journals (Sweden)

    Ashalata

    2011-01-01

    Full Text Available Tuberculous osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections andneoplastic diseases involving the mandible. Although a rare occurrence, the differential diagnosis of tuberculous osteomyelitismust always keep in dentist’s mind when the routine therapy fails to respond. Here, we report an unusual case of primarytubercular osteomyelitis of the mandible where the biopsy of the lesion alone has lead to near final diagnosis of the case andthere after antitubercular therapy subsided the swelling.

  13. Osteomyelitis of the mandible due to Aggregatibacter (Actinobacillus actinomycetemcomitans

    Directory of Open Access Journals (Sweden)

    Antony Beena

    2009-01-01

    Full Text Available Aggregatibacter (Actinobacillus actinomycetemcomitans is a capnoic gram negative coccobacilli known to produce juvenile periodontitis. This organism was isolated in pure culture from an unusual case of osteomyelitis of the mandible. The patient was treated with tetracycline, which is the drug of choice for A. actinomycetemcomitans and the clinical response improved. From our limited review of the literature, it appears that this is the first case of osteomyelitis due to A.actinomycetemcomitans reported in India.

  14. Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

    Directory of Open Access Journals (Sweden)

    Recep Tekin

    2015-01-01

    Full Text Available Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition.

  15. Post-traumatic osteomyelitis due to aeromonas species

    Directory of Open Access Journals (Sweden)

    Gunasekaran L

    2009-01-01

    Full Text Available We report a case of Aeromonas osteomyelitis due to injury in a sewage worker. He presented with cellulitis of the left foot. Radiographs showed evidence of osteomyelitis involving the head and neck of the fifth metatarsal. Aeromonas species was isolated from the tissue and swab from the foot. The head and neck of the fifth metatarsal were excised and the patient improved on 4 weeks of intravenous meropenem followed by 4 weeks of oral clindamycin and ciprofloxacin.

  16. Phage therapy of staphylococcal chronic osteomyelitis in experimental animal model

    Directory of Open Access Journals (Sweden)

    Chandan Kishor

    2016-01-01

    Full Text Available Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA are the commonest cause of osteomyelitis. The aim of this study was to evaluate the role of an alternative therapy i.e. application of S. aureus specific bacteriophages in cases of osteomyelitis caused by MRSA in animal model. Methods: Twenty two rabbits were included in this study. The first two rabbits were used to test the safety of phage cocktail while the remaining 20 rabbits were divided into three groups; group A (n=4 to assess the establishment of osteomyelitis; group B (n=4 osteomyelitis developed but therapy started only after six weeks; and group C (n=12 osteomyelitis developed and therapy started after three weeks. Groups B and C rabbits were treated with four doses of cocktail of seven virulent bacteriophages at the interval of 48 h. Comparison between three groups was made on the basis of observation of clinical, radiological, microbiological, and histopathological examinations. Results: Experimental group rabbits recovered from the illness in the subsequent two weeks of the therapy. Appetite and activity of the rabbits improved, local oedema, erythema and induration subsided. There were minimal changes associated with osteomyelitis in X-ray and histopathology also showed no signs of infection with new bone formation. Control B group rabbits also recovered well from the infection. Interpretation & conclusions: The present study shows a potential of phage therapy to treat difficult infections caused by multidrug resistant bacteria.

  17. Kingella kingae osteoarthritis and osteomyelitis in children.

    Science.gov (United States)

    Clément, J L; Berard, J; Cahuzac, J P; Gaubert, J

    1988-01-01

    Kingella kingae is still a poorly understood germ which is responsible for osteoarticular infections. We observed nine cases of osteoarthritis involving K. kingae in children. They included 4 cases of arthritis, 2 of osteomyelitis, and 3 of spondylodiscitis. The germ was cultured in all cases by direct surgical approach or by needle aspiration of the septic locus. Evolution was always good after immobilization and nonspecific antibiotherapy. Our nine clinical cases, along with the few cases already published, allow us to state that K. kingae shows a strong affinity for bones and joints in the young child. Clinical presentation is nonspecific. The bacterial sampling must be cultured in enriched atmospheres (CO2). The strains are sensitive to most common antibiotics.

  18. Serratia marcescens osteomyelitis in Cushing's disease.

    Science.gov (United States)

    Martins, Hugo F G; Raposo, Alexandra; Baptista, Isabel; Almeida, Julio

    2015-11-30

    We report a case of a 46-year-old man with fever, hypotension and arthralgias of the ankles and knees after brain surgery for a pituitary tumour causing Cushing's disease. Blood and urine cultures isolated Serratia marcescens; antibiotic susceptibility testing showed sensitivity to piperacillin-tazobactan and ciprofloxacin. Articular MRI showed inflammation and necrosis of both knees and ankles, and left hip and right elbow (compatible with osteomyelitis). Culture of an ankle abscess on the ankle joint was positive for Serratia marcescens. Bone scintigraphy confirmed osteomyelitic lesions. Medical treatment included antibiotics and strong opioid therapy for 14 weeks. The patient was discharged clinically improved maintaining ciprofloxacin for 24 additional weeks based on clinical and analytic recovery.

  19. Erysipelothrix Rhusiopathiae Endocarditis and Presumed Osteomyelitis

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    Marc Romney

    2001-01-01

    Full Text Available Erysipelothrix rhusiopathiae is known to cause infections in humans following exposure to decaying organic matter or animals colonized with the organism, such as swine and fish. Invasive infections with this organism are unusual and are manifested primarily as infective endocarditis. The present report is believed to be the first to report a case of E rhusiopathiae endocarditis and presumptive osteomyelitis. E rhusiopathiae appears to have intrinsic resistance to vancomycin. Because vancomycin is often used empirically for the treatment of endocarditis, rapid differentiation of E rhusiopathiae> from other Gram-positive organisms is critical. In patients with endocarditis caused by a Gram-positive bacillus and epidemiological risk factors for E rhusiopathiae exposure, empirical treatment with vancomycin should be reconsidered.

  20. Complete Genome and Plasmid Sequences of Staphylococcus aureus EDCC 5055 (DSM 28763), Used To Study Implant-Associated Infections

    Science.gov (United States)

    Mannala, Gopala Krishna; Hain, Torsten; Spröer, Cathrin; Bunk, Boyke; Overmann, Jörg; Alt, Volker

    2017-01-01

    ABSTRACT Staphylococcus aureus EDCC 5055 (DSM 28763) is a human clinical wound isolate intensively used to study implant-associated infections in rabbit and rat infection models. Here, we report its complete genome sequence (2,794,437 bp) along with that of one plasmid (27,437 bp). This strain belongs to sequence type 8 and contains a mecA gene. PMID:28232428

  1. Development of immunization trials against Acinetobacter baumannii

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    Tarek A. Ahmad

    2016-01-01

    Full Text Available Acinetobacter baumannii has recently crossed all lines once considered harmless, pushing its way as a nosocomial pathogen. It had acquired resistance to almost all available chemotherapies and mainly targets intensive care residents; causing pneumonia and major outbreaks with high mortality rates. This urged the need for preventive methods, which include infection control, non-specific immune-therapy, passive, and active immunization in order to offer vulnerable immune-compromised patients a flare in the dark. Several attempts were done for constructing effective vaccines with promising results. These are precisely classified, documented, and discussed in this up-to-date review.

  2. Case report 834: Chronic sclerosing osteomyelitis of the mandible with long bone periostitis.

    Science.gov (United States)

    Stewart, A; Carneiro, R; Pollock, L; Shaw, D

    1994-04-01

    We present the case of a patient with primary chronic osteomyelitis of the mandible, the radiological appearance of which is compatible with a diagnosis of chronic sclerosing osteomyelitis. The accompanying femoral and tibial periosteal reactive new bone formation and the benign clinical course suggest that this presentation may represent a form of chronic multifocal osteomyelitis.

  3. Imaging of chronic osteomyelitis; Chronische Infektionen des Skelettsystems. Bildgebende Diagnostik

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    Glaser, C.; Matzko, M.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik

    2000-06-01

    The diagnosis of chronic osteomyelitis is made on the basis of clinical, radiologic and histologic findings. The role of imaging in patients with known chronic osteomyelitis is to detect and to delineate areas of active infection. To correctly interpret the imaging findings, it is essential to take both the individual clinical findings and previous imaging studies into account. Reliable signs of active infection are bone marrow abscess, sequestra and sinus tract formation. Only the combined evaluation of bony changes together with alterations of the adjacent soft tissues provides good diagnostic accuracy. Projection radiography gives an overview of the condition of the bone, which provides the basis for follow-up and the selection of further imaging modalities. Computed tomography can be used to evaluate even discrete or complex bony alterations and to guide percutaneous biopsy or drainage. Magnetic resonance imaging achieves the best diagnostic sensitivity and specificity and provides superior contrast as well as anatomical resolution in both bone marrow and soft tissues. In this paper the features and clinical relevance of imaging in primary chronic osteomyelitis, posttraumatic osteomyelitis, tuberculous spondylitis and osteomyelitis of the diabetic foot are reviewed, with particular respect to MRI. (orig.) [German] Die Diagnose der chronischen Osteomyelitis wird durch Klinik, Bildgebung und Histologie gestellt. Bei bekannter chronischer Osteomyelitis soll die Bildgebung einen floriden Prozess und die betroffenen Kompartimente herausarbeiten. Die Klinik des Patienten, seine individuelle Krankheitskonstellation und die Verlaufsbeobachtung sind essentiell fuer die Befundinterpretation. Erst die kombinierte Beurteilung der Veraenderungen am Knochen selbst sowie die der umgebenden Weichteile fuehrt zu einer validen Aussage. Sichere Zeichen einer floriden Osteomyelitis sind lediglich (Knochenmarks)abzess, Sequester und Fistelgang. Die Projektionsradiographie gibt

  4. A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

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    Hakan Uslu

    2011-03-01

    Full Text Available Osteomyelitis of the calvarial bones can cause serious complications such as brain abscess, due to the close proximity to adjacent brain structures. Development of the purulent secretion in surgery and traumatic scalp injuries must be considered as a possibility of osteomyelitis possibility. Generally gram positive, rarely gram negative bacteria and mix agents, can be isolated in infection. Especially chronic pyogenic osteomyelitis agents can be isolated from chronic infections such as tuberculosis. In cranial osteomyelitis diagnosis, radiological diagnosis has a very important place together with the clinical diagnosis. However, infection can usually show late findings radiologically. In treatment, antibiotic treatment is absolutely essential as well as removal of the infected part of the bone. Due to antibiotic treatment lasting between 6-12 weeks, organizing the antibiotic protocols according to the results of culture-antibiograms, which were provided from purulent secretions, has the most important role in the success of surgical treatment. In Proteus sp. infections, for choice of suitable treatment, determination of the type of bacteria is important. For exact diagnosis, histopathological examination of the bone tissue must be carried out. In this report, a case with cranial osteomyelitis caused by Proteus vulgaris which is a gram negative bacteria causing anaerobic infections and classified in the Enterobacteriaceae family is presented. The patient was treated with surgery and appropriate antibiotics. Early recognition of this condition, planning the best treatment strategy and taking precautions to prevent complications, is mandatory for a better outcome.

  5. Microbiota associated with chronic osteomyelitis of the jaws

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    Elerson Gaetti-Jardim Júnior

    2010-12-01

    Full Text Available Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37ºC for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors.

  6. Staphylococcal endogenous endophthalmitis in association with pyogenic vertebral osteomyelitis.

    Science.gov (United States)

    Steeples, L R; Jones, N P

    2016-01-01

    PURPOSE To describe pyogenic vertebral osteomyelitis as a rare infection associated with endogenous endophthalmitis.METHODS A retrospective review of three patients with endogenous endophthalmitis and sepsis due to underlying Staphylococcal vertebral osteomyelitis presenting during a 21-month time period. The ophthalmic and systemic features and management and outcomes are presented.RESULTS One patient developed unilateral endophthalmitis with cervical spine osteomyelitis, Staphylococcus aureus being isolated from blood cultures. The second presented with bilateral endophthalmitis with disseminated Methicillin-resistant S. aureus (MRSA) infection, with thoracic and lumbar discitis and para-spinal abscesses. MRSA was cultured from vitreous, blood, and synovial fluid. Both patients received prolonged courses of intravenous antibiotics. Intravitreal antibiotic therapy was used in the second patient. Excellent visual and systemic outcomes were achieved in both cases with no ocular complications. The third patient developed lumbar osteomyelitis following spinal surgery and presented with disseminated S. aureus sepsis including unilateral endogenous endophthalmitis. Despite systemic antibiotics and intensive care the patient died.CONCLUSIONS Endogenous endophthalmitis should be suspected in septic patients developing eye symptoms. Endogenous endophthalmitis with staphylococcal bone infection is a rare but serious condition. Osteomyelitis should be considered as an infective source in any such patient reporting bone pain or reduced spinal mobility. Prompt investigation and treatment can achieve favourable visual and systemic outcomes.

  7. [Case report: cutaneous tuberculosis and tuberculous osteomyelitis].

    Science.gov (United States)

    Celikbaş, Aysel Kocagul; Ulu, Ayfegül; Ergönül, Onder; Eren, Sebnem; Baykam, Nurcan; Dokuzoguz, Başak

    2005-01-01

    In this report, a 27 years old male patient diagnosed to have skin and bone tuberculosis (TB) has been presented. The patient admitted to the hospital with the complaints of fever, weight loss and night sweats. Patient's history revealed that following a trauma a skin lesion in the right ankle was developed and this was followed by the development of many lesions in different parts of the body. The lesions persisted despite the use of various antibiotics since a year. It has been recorded that his father has already been receiving anti-tuberculosis treatment. Osteomyelitis was detected in the distal part of right tibia by computerized tomography, and Mycobacterium tuberculosis was isolated from the specimens of skin lesion. The patient was immunocompetent, and there was no pulmonary involvement. Isoniazid (INAH), rifampin (RIF), ethambutol and morphozinamid therapy has been started and completed to 12 months with INAH and RIF. In the post-treatment follow-up of patient for one year, no relapse was detected. As a result, tuberculosis should be considered in patients with persistent skin lesions especially in endemic countries.

  8. Genetic tools for manipulating Acinetobacter baumannii genome: an overview.

    Science.gov (United States)

    Biswas, Indranil

    2015-07-01

    Acinetobacter baumannii is an emerging nosocomial pathogen involved in a variety of infections ranging from minor soft-tissue infections to more severe infections such as ventilator-associated pneumonia and bacteraemia. A. baumannii has become resistant to most of the commonly used antibiotics and multidrug-resistant isolates are becoming a severe problem in the healthcare setting. In the past few years, whole-genome sequences of >200 A. baumannii isolates have been generated. Several methods and molecular tools have been used for genetic manipulation of various Acinetobacter spp. Here, we review recent developments of various genetic tools used for modification of the A. baumannii genome, including various ways to inactivate gene function, chromosomal integration and transposon mutagenesis.

  9. OXA-type carbapenemases in Acinetobacter baumannii in South America.

    Science.gov (United States)

    Opazo, Andrés; Domínguez, Mariana; Bello, Helia; Amyes, Sebastian G B; González-Rocha, Gerardo

    2012-04-13

    Acinetobacter baumannii is an opportunistic pathogen that is frequently involved in outbreaks of infection, occurring mostly in intensive care units. The increasing incidence of carbapenem resistance in A. baumannii worldwide is a concern since it limits drastically the range of therapeutic alternatives. The most important mechanism of carbapenem resistance is the enzymatic hydrolysis mediated by carbapenemases. In A. baumannii these enzymes are usually OXA-type carbapenemases, and belong to class D according to the classification of Ambler. The OXA-type carbapenemases are divided into five subgroups, four of which correspond to acquired carbapenemases, which accounts for the distribution of genes blaOXA in different geographic areas. In this work we review the different types of OXA-type carbapenemases present in A. baumannii, emphasizing the current situation in South America with special mention to the findings in Chile.

  10. [Acute osteomyelitis and septic arthritis in children: one year experience].

    Science.gov (United States)

    Timsit, S; Pannier, S; Glorion, C; Chéron, G

    2005-01-01

    To describe bacteriologic epidemiology of bone and joint infections, a total of 52 osteomyelitis, 52 arthritis and 20 osteoarthritis of children aged one month to 15 years during a one-year period (2001) were included in a retrospective unicentric review. The mean age was 3,9 +/-3,6 years. Fever and pain were the most common clinical symptoms. The site of infection was single in 95%, involving lower extremities in 80%. Bone scintigraphy was abnormal in 71% of osteomyelitis. Positive cultures was obtained in 29% of all cases (blood cultures: 20%, aspiration cultures: 29%), but in 42% of cases which have both blood and aspiration cultures. Thirty-six bacteria were identified: 19 Staphylococcus (14 aureus), ten Streptococcus (four pneumoniae), three Salmonella, three Kingella kingae, one Moraxella. All the isolates were susceptible to the empiric antibiotic therapy. Outcome was good in 100% of osteomyelitis and in 96% of arthritis.

  11. Syndromes with chronic non-bacterial osteomyelitis in the spine.

    Science.gov (United States)

    Kubaszewski, Łukasz; Wojdasiewicz, Piotr; Rożek, Marcin; Słowińska, Iwona E; Romanowska-Próchnicka, Katarzyna; Słowiński, Radosław; Poniatowski, Łukasz A; Gasik, Robert

    2015-01-01

    Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background - chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome - that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice.

  12. Emphysematous osteomyelitis: a case report and review of the literature.

    Science.gov (United States)

    Luey, Christopher; Tooley, Debbie; Briggs, Simon

    2012-03-01

    We report the case of a 15-year-old girl with pelvic and sacral emphysematous osteomyelitis caused by Fusobacterium necrophorum. This infection was cured following four surgical procedures and 4 weeks of intravenous then 4 weeks of oral antibiotics. We review our case alongside the 24 previously reported cases of emphysematous osteomyelitis in the literature. The 25 cases include 15 monomicrobial and 10 polymicrobial infections. The causative organism(s) in all but three cases included an anaerobe or a member of the Enterobacteriaceae family. A significant underlying comorbidity was reported in 18 cases. At least 15 cases required one or more surgical procedures. There was a significant associated mortality with eight (32%) patients dying in hospital at 7 to 56 days after the diagnosis of emphysematous osteomyelitis.

  13. Radiation osteomyelitis of the mandible. Report of two cases

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    Molla, M.R.; Nishio, Juntaro; Matsuya, Tokuzo; Miyazaki, Tadashi (Osaka Univ. (Japan). School of Dentistry)

    1982-12-01

    Radiation therapy for the head and neck malignant tumor may often cause osteoradionecrosis of the mandible, leading to radiation osteomyelitis with a source of infection. The present study demonstrates two cases with radiation osteomyelitis of the mandible to discuss the etiology, radiological findings and preventive measure for this type of bone disease. The results indicate that, 1) A higher dose in external radiotherapy may claimed to be a potent factor to cause osteoradionecrosis and post irradiation periodontitis of the tooth associated with pain, may be preliminary symptom of leading radiation osteomyelitis, where a delayed healing of tooth extraction is an accelerating factor responsible for rapid progress of osteomyelitic changes. 2) Once infection sets in post irradiated bone, radio-osteomyelitic change is quite progressive even after various conservative measure. 3) Only radiological change in those cases is a slow formation of sequestrum time ranging from 7 to 10 months, with a gradual separation of dead bone as a large mass.

  14. Subperiosteal abscess in a child. Trueta's osteomyelitis hypothesis undermined?

    Science.gov (United States)

    Weenders, S G M; Janssen, N E; Landman, G W D; van den Berg, F P

    2015-10-01

    Subperiosteal abscess formation is almost exclusively seen secondary to underlying hematogenous infected osteomyelitis or secondary as a result of a contagious focus. We present an unusual case of a 9-year-old girl with progressive ankle pain due to an isolated subperiosteal abscess of the distal fibula without concomitant osteomyelitis. The subperiosteal abscess was most likely caused by hematogenous spread to the periosteal region of the distal fibula located above the highly vascularized metaphysis. Remarkably, there were no signs of osteomyelitis on either MRI or during surgical inspection. She was successfully treated with debridement and antibiotic therapy. We hypothesize that subperiosteal abscess formation near the metaphysis originates in the periosteal region and not from outward extension from the sinusoidal veins in the intrametaphyseal area to the cortex and subperiosteal region.

  15. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

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    Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2011-09-15

    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A {sup 99mT}c MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  16. Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    Tamyris Inácio Oliveira

    2014-01-01

    Full Text Available Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion.

  17. SUCCESSFUL TREATMENT OF OSTEOMYELITIS IN LEPROSY PATIENTS BY HOMEOPATHIC MEDICINE

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    D. Chakraborty

    2013-12-01

    Full Text Available Osteomyelitis, a major complication of neuropathic feet in leprosy may occur as a result of infiltration of Mycobacterium leprae in the periosteum of bones or due to secondary bacterial infection of chronic plantar ulcer. There is no effective treatment for healing of planter ulcer and osteomyelitis. Keeping in mind of the limitation of conservative treatment, twenty patients who completed with multi drug therapy but suffering from neuropathic foot with ulcer was treated with Mercurius solubilis, a homoeopathic medicine in 200 potency for one year. All these patients had different degrees of osteomyelitic changes and after treatment showed regeneration and remodeling of bones which may be considered as significant improvement. Based on the radiological finding it may be concluded that Mercurius solubilis found to be effective in the treatment of osteomyelitis in leprosy affected patients.

  18. Syndromes with chronic non-bacterial osteomyelitis in the spine

    Science.gov (United States)

    Kubaszewski, Łukasz; Wojdasiewicz, Piotr; Rożek, Marcin; Romanowska-Próchnicka, Katarzyna; Słowiński, Radosław; Poniatowski, Łukasz A.; Gasik, Robert

    2016-01-01

    Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background – chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome – that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice. PMID:27407266

  19. Ribotyping of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex.

    OpenAIRE

    Gerner-Smidt, P

    1992-01-01

    The Acinetobacter calcoaceticus-Acinetobacter baumannii complex consists of four genotypically distinct but phenotypically very similar bacterial species or DNA groups: A. calcoaceticus (DNA group 1), A. baumannii (DNA group 2), unnamed DNA group 3 (P. J. M. Bouvet and P. A. D. Grimont, Int. J. Syst. Bacteriol. 36:228-240, 1986), and unnamed DNA group 13 (I. Tjernberg and J. Ursing, APMIS 97:595-605, 1989). Because strains in this complex cause nosocomial outbreaks, it is important to be able...

  20. Acinetobacter baumannii: biology and drug resistance - role of carbapenemases.

    Science.gov (United States)

    Nowak, Pawel; Paluchowska, Paulina

    2016-01-01

    Acinetobacter baumannii is a Gram-negative, glucose-non-fermenting, oxidase-negative coccobacillus, most commonly associated with the hospital settings. The ability to survive in adverse environmental conditions as well as high level of natural and acquired antimicrobial resistance make A. baumannii one of the most important nosocomial pathogens. While carbapenems have long been considered as antimicrobials of last-resort, the rates of clinical A. baumannii strains resistant to these antibiotics are increasing worldwide. Carbapenem resistance among A. baumannii is conferred by coexisting mechanisms including: decrease in permeability of the outer membrane, efflux pumps, production of beta-lactamases, and modification of penicillin-binding proteins. The most prevalent mechanism of carbapenem resistance among A. baumannii is associated with carbapenem-hydro-lysing enzymes that belong to Ambler class D and B beta-lactamases. In addition, there have also been reports of resistance mediated by selected Ambler class A carbapenemases among A. baumannii strains. Resistance determinants in A. baumannii are located on chromosome and plasmids, while acquisition of new mechanisms can be mediated by insertion sequences, integrons, transposons, and plasmids. Clinical relevance of carbapen-em resistance among strains isolated from infected patients, carriers and hospital environment underlines the need for carbapenemase screening. Currently available methods vary in principle, accuracy and efficiency. The techniques that deserve particular attention belong to both easily accessible unsophisticated methods as well as advanced techniques based on mass spectrometry or molecular biology. While carbapenemases limit the therapeutic options in A. baumannii infections, studies concerning novel beta-lactamase inhibitors offer a new insight into effective therapy.

  1. Prevalence of Aminoglycoside Resistance Genes in Acinetobacter baumannii Isolates

    OpenAIRE

    Aliakbarzade, Katayun; Farajnia, Safar; Karimi Nik, Ashraf; Zarei, Farzaneh; Tanomand, Asghar

    2014-01-01

    Background: Acinetobacter baumannii is one of the major causes of nosocomial infections and is resistant to most available antibiotics. Aminoglycosides remain as drugs of choice for treatment of Acinetobacter infections yet resistance to aminoglycosides has increased in the recent years. Objectives: The present study investigated the prevalence of genes encoding aminoglycoside-modifying enzymes in A. baumannii strains isolated from patients of Tabriz city, northwest of Iran. Materials and Met...

  2. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study

    Directory of Open Access Journals (Sweden)

    Reiseter Tor

    2008-10-01

    Full Text Available Abstract Background Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute ( Methods In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. Results The total annual incidence rate of osteomyelitis was 13 per 100 000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100 000. The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3–3.7. The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002. Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3–14.7. ESR ≥ 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43% patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. Conclusion The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.

  3. Update: Cytokine Dysregulation in Chronic Nonbacterial Osteomyelitis (CNO

    Directory of Open Access Journals (Sweden)

    Sigrun R. Hofmann

    2012-01-01

    Full Text Available Chronic nonbacterial osteomyelitis (CNO with its most severe form chronic recurrent multifocal osteomyelitis (CRMO is a non-bacterial osteitis of yet unknown origin. Secondary to the absence of both high-titer autoantibodies and autoreactive T lymphocytes, and the association with other autoimmune diseases, it was recently reclassified as an autoinflammatory disorder of the musculoskeletal system. Since its etiology is largely unknown, the diagnosis is based on clinical criteria, and treatment is empiric and not always successful. In this paper, we summarize recent advances in the understanding of possible etiopathogenetic mechanisms in CNO.

  4. [Postoperative Osteomyelitis of a Distal Phalanx Caused by Raoultella ornithinolytica].

    Science.gov (United States)

    Schmutz, N; Adler, T; Schelhorn, N; Wirz, S; Fricker, R

    2016-06-01

    We report on a case of osteomyelitis of a distal phalanx of the right ring finger of a 62-year-old patient, which occurred 11 months after transosseous-transungual refixation of a closed flexor digitorum profundus tendon avulsion caused by Raoultella ornithinolytica. R. ornithinolytica is an encapsulated Gram-negative aerobic bacillus. In the literature only 13 cases of human infection by R. ornithinolytica are mentioned. To the best of our knowledge, this is the first case of an osteomyelitis caused by R. ornithinolytica.

  5. Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis.

    Science.gov (United States)

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

    2014-10-01

    One of the most devastating foot and/or ankle complications in the diabetic population with peripheral neuropathy is the presence of Charcot neuroarthropathy (CN). In recent years, diabetic limb salvage has been attempted more frequently as opposed to major lower extremity amputation for CN of the foot and ankle with ulceration and/or deep infection. Treatment strategies for osteomyelitis in the diabetic population have evolved. This article reviews some of the most common surgical strategies recommended for the diabetic patient with CN of the foot and/or ankle and concomitant osteomyelitis.

  6. Chronic recurrent multifocal osteomyelitis--report of eight patients.

    Science.gov (United States)

    Handrick, W; Hörmann, D; Voppmann, A; Schille, R; Reichardt, P; Tröbs, R B; Möritz, R P; Borte, M

    1998-12-01

    The authors undertook a retrospective review of the clinical records and radiologic findings of eight children with chronic, recurrent multifocal osteomyelitis (CRMO). This disease is a recognized clinicopathologic entity with typical radiographic findings, mostly in the metaphyses of the long bones. The diagnosis is one of exclusion without pathognomonic findings. The patients were treated with non-steroidal anti-inflammatory drugs. There was no evidence of altered bone growth or abnormal joint development. It is concluded that CRMO is a distinct clinical entity that is different from acute or subacute bacterial osteomyelitis. Recognition of this condition is important to avoid treatment with antibiotics and repeated operations.

  7. Sternal osteomyelitis after bacillus Calmette-Guérin vaccination

    Directory of Open Access Journals (Sweden)

    Rolandas Selvestravičius

    2016-09-01

    Full Text Available Presented here is the case of a nine-month-old boy with the osteomyelitis of the upper area sternum caused by bacillus Calmette-Guerin (BCG, the Danish 1331 strain vaccine against tuberculosis. Upon examination, a swelling of approximately 2×3 cm diameter was observed in the upper sternal area. The mass was hard, fixed and sensitive to palpation with no local skin hyperaemia. Chest X-rays revealed a round mass anterior to the sternum, suggesting a diagnosis of osteomyelitis. A consequent sternal biopsy was performed and Mycobacterium bovis BCG was identified by a positive growth culture.

  8. Osteomyelitis of the foot and ankle: diagnosis, epidemiology, and treatment.

    Science.gov (United States)

    Lindbloom, Benjamin J; James, Eric R; McGarvey, William C

    2014-09-01

    Osteomyelitis of the foot and ankle is a common, potentially devastating condition with diagnostic and treatment challenges. Understanding the epidemiology and pathogenesis of osteomyelitis can raise clinical suspicion and guide testing and treatments. History and physical examination, laboratory studies, vascular studies, histologic and microbiologic analyses, and various imaging modalities contribute to diagnosis and treatment. Treatment including empiric broad-spectrum antibiotics and surgery should take a multidisciplinary approach to optimize patient factors, ensure eradication of the infection, and restore function. Optimization of vascular status, soft tissues, limb biomechanics, and physiologic state of the patient must be considered to accelerate and ensure healing.

  9. Calcaneal osteomyelitis due to Achromobacter xylosoxidans: a case report.

    Science.gov (United States)

    Ozer, Kadri; Kankaya, Yuksel; Baris, Ruser; Bektas, Cem Inan; Kocer, Ugur

    2012-12-01

    Achromobacter xylosoxidans (A. xylosoxidans) has been described as an opportunistic pathogen causing infection. The case we describe is that of an elderly man who had osteomyelitis of calcaneal bone caused by A. xylosoxidans. As far as we are aware there are only 5 cases of osteomyelitis with A. xylosoxidans in the literature. Impaired defensive mechanism of the foot in direct contact with this waterborne bacterium can cause this disease. Because of the high level of antibiotic resistance of this bacterium, clinically more attention should be paid to patients who have impaired defensive mechanisms in their extremities, for example free flaps.

  10. Sternal Osteomyelitis after Bacillus Calmette-Guérin Vaccination

    Science.gov (United States)

    Selvestravičius, Rolandas; Sučilienė, Elena; Saniukas, Kęstutis; Bobelytė, Odeta; Usonis, Vytautas

    2016-01-01

    Presented here is the case of a nine-month-old boy with the osteomyelitis of the upper area sternum caused by bacillus Calmette-Guerin (BCG), the Danish 1331 strain vaccine against tuberculosis. Upon examination, a swelling of approximately 2×3 cm diameter was observed in the upper sternal area. The mass was hard, fixed and sensitive to palpation with no local skin hyperaemia. Chest X-rays revealed a round mass anterior to the sternum, suggesting a diagnosis of osteomyelitis. A consequent sternal biopsy was performed and Mycobacterium bovis BCG was identified by a positive growth culture. PMID:27777704

  11. Chronic sclerosing osteomyelitis of the iliac bone. Etiological possibilities

    Energy Technology Data Exchange (ETDEWEB)

    Jurik, A.G.; Moeller, S.H.; Mosekilde, L.

    1988-03-01

    An adolescent with chronic recurrent multifocal osteomyelitis located to both iliac bones and an adult with pustulotic arthro-osteitis, involving the left iliac bone, an invertebral space, and the sternoclavicular, first sternocostal, manubriosternal and single peripheral joints are described. Their iliac bone changes were identical, except for the occurrence of bilateral changes in the adolescent, and ankylosis of the sacroiliac joint in the adult. It is suggested that chronic recurrent multifocal osteomyelitis and pustulotic arthro-osteitis may be related diseases with age-dependent differences.

  12. Endemic Acinetobacter baumannii in a New York hospital.

    Directory of Open Access Journals (Sweden)

    Scott A Weisenberg

    Full Text Available BACKGROUND: Acinetobacter baumannii is an increasingly multidrug-resistant (MDR cause of hospital-acquired infections, often associated with limited therapeutic options. We investigated A. baumannii isolates at a New York hospital to characterize genetic relatedness. METHODS: Thirty A. baumannii isolates from geographically-dispersed nursing units within the hospital were studied. Isolate relatedness was assessed by repetitive sequence polymerase chain reaction (rep-PCR. The presence and characteristics of integrons were assessed by PCR. Metabolomic profiles of a subset of a prevalent strain isolates and sporadic isolates were characterized and compared. RESULTS: We detected a hospital-wide group of closely related carbapenem resistant MDR A. baumannii isolates. Compared with sporadic isolates, the prevalent strain isolates were more likely to be MDR (p = 0.001. Isolates from the prevalent strain carried a novel Class I integron sequence. Metabolomic profiles of selected prevalent strain isolates and sporadic isolates were similar. CONCLUSION: The A. baumannii population at our hospital represents a prevalent strain of related MDR isolates that contain a novel integron cassette. Prevalent strain and sporadic isolates did not segregate by metabolomic profiles. Further study of environmental, host, and bacterial factors associated with the persistence of prevalent endemic A. baumannii strains is needed to develop effective prevention strategies.

  13. Vertebral manifestation of chronic recurrent multifocal osteomyelitis (CRMO); Wirbelsaeulenmanifestationen der chronischen rekurrierenden multifokalen Osteomyelitis (CRMO)

    Energy Technology Data Exchange (ETDEWEB)

    Schilling, F. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Rheinland-Pfaelzisches Rheumazentrum, Mainz/Bad Kreuznach (Germany); Fedlmeier, M. [Rheuma-Kinderklinik, Garmisch-Partenkirchen (Germany); Eckardt, A. [Mainz Univ. (Germany). Orthopaedische Klinik und Poliklinik; Kessler, S. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie

    2002-10-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a systemic osteo-articular disease that is characterized by a sterile, primarily chronic osteomyelitis with various distribution patterns of the individual lesions. In this article, we describe the 'axial type' with predominant involvement of the spine, which represents 13 of our 41 CMRO cases of different age groups. The important element of its diagnosis is the typical lympho-plasmacellular spondylitis that can be detected and staged by scintigraphy, MRI and conventional radiography. Potentially affected are all vertebrae from the mid-cervical spine to the sacrum. One or several segments can be involved, sometimes as transient inflammatory edema, sometimes as 'migratory spondylitis' or 'saltatory spondylitis', but also as chronic sclerosing type with early radiographically detectable manifestation. Vertebral deformity due to compression and total collapse (vertebra plana) are rare. A complicated course with patulous perivertebral edema can lead to concomitant symptomatic inflammatory changes in adjacent regions and organs. In the course of CRMO, spondylodiscitis only develops as secondary destruction following the spondylitis. This can help to differentiate spondyloarthropathies from CRMO that is initially detected as primary lesion in the spine. While CRMO generally has a good prognosis, its radiological differentiation from rheumatology conditions plays an important role. (orig.) [German] Die chronische rekurrierende multifokale Osteomyelitis (CRMO) ist ein osteo-artikulaeres Systemleiden, das durch sterile, primaer chronische Osteomyelitiden gekennzeichnet ist und mit krankheitsdominanten Lokalisationen verschiedene Befallmustertypen aufweist. In dieser Arbeit wird die Wirbelsaeulenmanifestation ('Vertebraltyp') geschildert, die ein Drittel aller CRMO-Faelle betrifft und im Rahmen unseres CRMO-Kollektivs (n=41) mit 13 Faellen aller Altersstufen vertreten ist. Das

  14. Regulation of Acinetobacter baumannii biofilm formation.

    Science.gov (United States)

    Gaddy, Jennifer A; Actis, Luis A

    2009-04-01

    Acinetobacter baumannii is a Gram-negative opportunistic nosocomial pathogen. This microorganism survives in hospital environments despite unfavorable conditions such as desiccation, nutrient starvation and antimicrobial treatments. It is hypothesized that its ability to persist in these environments, as well as its virulence, is a result of its capacity to form biofilms. A. baumannii forms biofilms on abiotic surfaces such as polystyrene and glass as well as biotic surfaces such as epithelial cells and fungal filaments. Pili assembly and production of the Bap surface-adhesion protein play a role in biofilm initiation and maturation after initial attachment to abiotic surfaces. Furthermore, the adhesion and biofilm phenotypes of some clinical isolates seem to be related to the presence of broad-spectrum antibiotic resistance. The regulation of the formation and development of these biofilms is as diverse as the surfaces on which this bacterium persists and as the cellular components that participate in this programmed multistep process. The regulatory processes associated with biofilm formation include sensing of bacterial cell density, the presence of different nutrients and the concentration of free cations available to bacterial cells. Some of these extracellular signals may be sensed by two-component regulatory systems such as BfmRS. This transcriptional regulatory system activates the expression of the usher-chaperone assembly system responsible for the production of pili, needed for cell attachment and biofilm formation on polystyrene surfaces. However, such a system is not required for biofilm formation on abiotic surfaces when cells are cultured in chemically defined media. Interestingly, the BfmRS system also controls cell morphology under particular culture conditions.

  15. Towards an explanation for the success of Acinetobacter baumannii in the human host

    OpenAIRE

    Breij, Anastasia (Anna)

    2012-01-01

    Acinetobacter baumannii is an important nosocomial pathogen responsible for outbreaks of infection worldwide. The studies presented in this thesis aimed to gain further insight into the bacterial and host factors associated with the pathogenesis of A. baumannii to seek an explanation for the clinical success of A. baumannii. We demonstrated that both A. baumannii and less virulent Acinetobacter species can adhere to surfaces and form a biofilm, albeit with a wide variation among strains of ea...

  16. Osteomyelitis and septic arthritis caused by Kingella kingae.

    OpenAIRE

    Davis, J M; Peel, M M

    1982-01-01

    The clinical and bacteriological findings in two cases of osteomyelitis and one case of septic arthritis caused by Kingella kingae are presented. This appears to be the first report providing clear evidence for a pathogenic role for this species in bone and joint infections.

  17. Osteomyelitis and septic arthritis caused by Kingella kingae.

    Science.gov (United States)

    Davis, J M; Peel, M M

    1982-02-01

    The clinical and bacteriological findings in two cases of osteomyelitis and one case of septic arthritis caused by Kingella kingae are presented. This appears to be the first report providing clear evidence for a pathogenic role for this species in bone and joint infections.

  18. Salmonella spinal osteomyelitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Acharya Shankar

    2004-10-01

    Full Text Available A case of vertebral osteomyelitis is presented where initial presumptive diagnosis of tuberculous infection was made on clinico-radiological grounds but eventually turned out to be Salmonella infection upon exploration, biopsy and culture. Patient recovered completely following debridement and appropriate antibiotics (fluoro-quinolones for a period of six weeks. Internal fixation allowed early ambulation.

  19. An orbital fistula complicating anaerobic frontal sinusitis and osteomyelitis

    NARCIS (Netherlands)

    H.J. Simonsz (Huib); H.J.F. Peeters; G.M. Bleeker

    1982-01-01

    textabstractA patient is described with an orbital fistula complicating frontal sinusitis and osteomyelitis of the frontal bone. The fistula was excised, but a fortnight later an acute exacerbation occurred. From the discharging pus a Staphylococcus aureus was cultured and from mucosa obtained durin

  20. Complications of Candidemia in ICU Patients: Endophthalmitis, Osteomyelitis, Endocarditis.

    Science.gov (United States)

    Kauffman, Carol A

    2015-10-01

    Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents.

  1. PVL PRODUCING MRSA OSTEOMYELITIS IN NEONATE - A RARE PRESENTATION

    Directory of Open Access Journals (Sweden)

    Nayana Prabha

    2014-01-01

    Full Text Available This is the first reported case of osteomyelitis caused by Panton - Valentine - Leucocidin (PVL producing (MRSA Methicillin Resistant Staphylococcus Aureus in a newborn. The presence of multiple abscesses , necrotizing fasciitis , severe leucopenia and thrombocytopenia should prompt one to cons ider PVL producing Community acquired - MRSA

  2. Osteomyelitis: a review of currently used imaging techniques

    Energy Technology Data Exchange (ETDEWEB)

    Sammak, B.; Abd El Bagi, M; Al Shahed, M.; Al Nabulsi, J.; Youssef, B.; Al Thagafi, M. [Department of Radiology, Riyadh Armed Forces Hospital, Riyadh (Saudi Arabia); Hamilton, D. [Department of Medical Physics, Riyadh Armed Forces Hospital (Saudi Arabia)

    1999-06-01

    Conventional radiographs remain the initial imaging modality involved in the diagnosis of osteomyelitis. Bone scintigraphy and its specific agents did not only eliminate the problems of inherent low sensitivity of conventional radiographs, but also increased the specificity to higher degrees. Spiral CT, on the other hand, has solved several diagnostic problems, such as osteomyelitis of the sterno-clavicular junction and hidden areas in the pelvic bones. Magnetic resonance imaging with its multiplanar capability, greater anatomic details and excellent soft tissue bone marrow contrast resolution has a significant role in surgical planning and limb preservation. Ultrasound and US-guided aspiration has recently been involved in the diagnosis and management of osteomyelitis with several advantages particularly in children. Our goal in this review is to outline the ability of various imaging techniques by comparing their strengths and weaknesses in the diagnosis of osteomyelitis. Finally, we suggest various imaging algorithms for specific clinical scenarios. Spondylitis and septic arthritis are not discussed in this review. (orig.) With 7 figs., 43 refs.

  3. Vertebral osteomyelitis associated with cat-scratch disease

    NARCIS (Netherlands)

    Hulzebos, CV; Koetse, HA; Kimpen, JLL; Wolfs, TFW

    1999-01-01

    We describe a patient with vertebral osteomyelitis and paravertebral soft-tissue collections associated with cat-scratch disease (CSD). Diagnosis was established on the basis of histologic examination and serological and polymerase chain reaction (PCR) tests. Treatment consisted of administration of

  4. Forbedret diagnostik af osteomyelitis hos børn?

    DEFF Research Database (Denmark)

    Afzelius, Pia; Alstrup, Aage Kristian Olsen; Schønheyder, Henrik Carl;

    Osteomyelitis er en alvorlig sygdom. Tidlig diagnose og påbegyndelse af behandlingen er vigtigt for at forhindre sygdomsudviklingen og for at reducere potentielt alvorlige komplikationer. Konventionel røntgenundersøgelse udført tidligt i forløbet kan ikke udelukke akut osteomyelitis. MRI......, knogleskintigrafi og CT er centrale billeddiagnostiske metoder til diagnostik af akut osteomyelitis hos børn. MRI betragtes ofte som værende den bedste billeddannende metode, men er ikke altid tilgængelig og kræver anæstesi af små børn. Knogleskintigrafi påviser osteoblastaktivitet og anses for at være yderst...... sensitiv men er ikke særlig specifik. 18F-fluordeoxyglucose (FDG) PET har måske den højeste diagnostiske nøjagtighed for bekræftelse/udelukkelse af kronisk osteomyelitis sammenlignet med knogleskintigrafi, MRI og leukocytskintigrafi. Imidlertid har de fleste studier kun anvendt 18F-FDG PET ved mistanke om...

  5. Treatment of chronic osteomyelitis with one-stage allograft

    Institute of Scientific and Technical Information of China (English)

    LU Wei-ju; LI Bin; BAO Ni-rong; QIAN Hong-bo; ZENG Xiao-feng; XU Bin; CHEN Yong; ZHAO Jian-ning

    2006-01-01

    Objective: To avoid disadvantages of two-stage cancellus bone autograft, we investigated the feasibility of one-stage allograft for reconstructing the bone defect resulting from debridement of chronic osteomyelitis in limbs.Methods: Between Feb. 1999 and Apr. 2004, 35 cases of chronic osteomyelitis (8 cases of nonunion )underwent one-stage allograft after debridement in our hospital.Results: Thirty-five cases were followed up for an average period of 28 months (range, 13 to 55 months), in which 32 cases (91.43%) were found no infection, and 3cases (8.57 %) were confirmed recurrence of infection.Four out of 8 cases of bone nonunion healed in 9.5 months on average (range, 3 to 12 months), and another case also acquired union after redebridement and autograft of ilium due to infection recurrence 35 days after surgery.Renonunion occurred in 3 cases, 2 out of whom healed after secondary operation with autograft. One case of renonunion and 2 cases of infection recurrence refused further treatment.Conclusions: A high rate of infection arrest can be attained when one-stage allograft is used to reconstruct the bone defect of chronic osteomyelitis after debridement in limbs. Therefore, chronic osteomyelitis should not be regarded as a contraindication to one-stage allogeneic bone grafting. Renonuion, however, achieves a relatively high rate, especially in cases of segmental bone defect.

  6. The MRI appearances of early vertebral osteomyelitis and discitis

    Energy Technology Data Exchange (ETDEWEB)

    Dunbar, J.A.T.; Sandoe, J.A.T. [Department of Microbiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Rao, A.S. [Department of Orthopaedics, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Crimmins, D.W. [Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Baig, W. [Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Rankine, J.J., E-mail: james.rankine@leedsth.nhs.u [Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Leeds Musculoskeletal Biomedical Research Unit, Leeds (United Kingdom)

    2010-12-15

    Aim: To describe the magnetic resonance imaging (MRI) appearances in patients with a clinical history suggestive of vertebral osteomyelitis and discitis who underwent MRI very early in their clinical course. Materials and methods: A retrospective review of the database of spinal infections from a spinal microbiological liaison team was performed over a 2 year period to identify cases with clinical features suggestive of spinal infection and an MRI that did not show features typical of vertebral osteomyelitis and discitis. All patients had positive microbiology and a follow up MRI showing typical features of spinal infection. Results: In four cases the features typical of spinal infection were not evident at the initial MRI. In three cases there was very subtle endplate oedema associated with disc degeneration, which was interpreted as Modic type I degenerative endplate change. Intravenous antibiotic therapy was continued prior to repeat MRI examinations. The mean time to the repeat examination was 17 days with a range of 8-22 days. The second examinations clearly demonstrated vertebral osteomyelitis and discitis. Conclusion: Although MRI is the imaging method of choice for vertebral osteomyelitis and discitis in the early stages, it may show subtle, non-specific endplate subchondral changes; a repeat examination may be required to show the typical features.

  7. Protein, Lipid, Chemical and Structural Signatures of Differentially-Cultivated Francisella tularensis and Acinetobactor baumannii

    Science.gov (United States)

    2014-03-05

    Resistant Strains of Acinetobacter baumannii , Antimicrobial Agents and Chemotherapy, (07 2013): 0. doi: 10.1128/AAC.00865-13 Bibiana V Iglesias...Q. Shanks, Y. Doi. Activities of Vancomycin-Containing Regimens against Colistin-Resistant Acinetobacter baumannii Clinical Strains, Antimicrobial... Acinetobacter baumannii , Antimicrobial Agents and Chemotherapy (04 2013) TOTAL: 1 Received Paper TOTAL: PERCENT_SUPPORTEDNAME FTE Equivalent: Total

  8. Inverse PCR for subtyping of Acinetobacter baumannii carrying ISAba1.

    Science.gov (United States)

    Kim, Shukho; Park, Yun-Ju; Kim, Jungmin

    2016-05-01

    Acinetobacter baumannii has been prevalent in nosocomial infections, often causing outbreaks in intensive care units. ISAba1 is an insertion sequence that has been identified only in A. baumannii and its copy number varies among strains. It has been reported that ISAba1 provides a promoter for bla(OXA-51-like), bla(OXA-23-like), and bla(ampC), which are associated with the resistance of A. baumannii to carbapenems and cephalosporins. The main purpose of this study was to develop a novel inverse PCR method capable of typing A. baumannii strains. The method involves three major steps: cutting of genomic DNA with a restriction enzyme, ligation, and PCR. In the first step, bacterial genomic DNA was digested with DpnI. In the second step, the digested genomic DNAs were ligated to form intramolecular circular DNAs. In the last step, the ligated circular DNAs were amplified by PCR with primers specific for ISAba1 and the amplified PCR products were electrophoresed. Twenty-two clinical isolates of A. baumannii were used for the evaluation of the inverse PCR (iPCR) typing method. Dendrogram analysis revealed two major clusters, similar to pulsed-field gel electrophoresis (PFGE) results. Three ISAba1-associated genes--bla(ampC), bla(OXA-66-like), and csuD--were amplified and detected in the clinical isolates. This novel iPCR typing method is comparable to PFGE in its ability to discriminate A. baumannii strains, and is a promising molecular epidemiological tool for investigating A. baumannii carrying ISAba1.

  9. Cathodic voltage-controlled electrical stimulation of titanium for prevention of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii biofilm infections.

    Science.gov (United States)

    Canty, Mary; Luke-Marshall, Nicole; Campagnari, Anthony; Ehrensberger, Mark

    2017-01-15

    Antibiotic resistance of bacterial biofilms limits available treatment methods for implant-associated orthopaedic infections. This study evaluated the effects of applying cathodic voltage-controlled electrical stimulations (CVCES) of -1.5V and -1.8V (vs. Ag/AgCl) to coupons of commercially pure titanium (cpTi) incubated in cultures of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii (A. baumannii) as a method of preventing bacterial attachment. Stimulations were applied for 2, 4, and 8h and coupon-associated and planktonic colony-forming units (CFU) were enumerated following stimulation. Compared to open circuit potential (OCP) controls, CVCES for 4h at -1.8V significantly reduced coupon-associated MRSA CFU by 99.9% (1.30×10(4)vs. 4.45×10(7), p=0.047) and A. baumannii coupon-associated CFU by 99.9% (1.64×10(4)vs. 5.93×10(7), p=0.001) and reduced planktonic CFU below detectable levels for both strains. CVCES at -1.8V for 8h also reduced coupon-associated and planktonic CFU below detectable levels for each strain. CVCES at -1.5V for 4 and 8h, and -1.8V for 2h did not result in clinically relevant reductions. For 4 and 8h stimulations, the current density was significantly higher for -1.8V than -1.5V, an effect directly related to the rate of water and oxygen reduction on the cpTi surface. This significantly increased the pH, a suspected influence in decreased CFU viability. The voltage-dependent electrochemical properties of cpTi likely contribute to the observed antimicrobial effects of CVCES. This study revealed that CVCES of titanium could prevent coupon-associated and planktonic CFU of Gram-positive MRSA and Gram-negative A. baumannii from reaching detectable levels in a magnitude-dependent and time-dependent manner.

  10. Ertapenem for treatment of osteomyelitis: a case series

    Directory of Open Access Journals (Sweden)

    Johnson Melissa D

    2011-11-01

    Full Text Available Abstract Background Ertapenem is a once-daily broad spectrum carbapenem that is increasingly used to treat polymicrobial osteomyelitis due to diabetic foot and traumatic wound infections. However, limited data exists on ertapenem use for osteomyelitis. This study aimed to characterize outcomes and adverse effects with empiric use of ertapenem for osteomyelitis. Findings A total of 112 patients presenting to Duke, Durham Regional or Durham VA Medical Centers with a suspected diagnosis of osteomyelitis and ertapenem use from 11/2001 to 8/2009 were screened, and 12 subjects met inclusion criteria for the study. Mean age was 60 ± 16 years, 68% were female, 75% were Caucasian, and the most common comorbidities included diabetes (58%, peripheral vascular disease (42%, and history of tobacco use (75%. Over half of the patients presented to a primary care clinic or emergency room greater than six months after the onset of clinical symptoms. Bone culture was obtained for diagnostic guidance in only two cases; and surgical intervention was pursued in three cases. Patients received a mean duration of 34.6 ± 7.8 days of therapy, and in three cases, subsequent suppressive oral antibiotics were given. Six (50% patients met criteria for clinical success, defined as resolution of clinical signs and symptoms of infection such that discontinuation of antibiotics was deemed appropriate at end of ertapenem therapy, without recurrence at one year follow-up. No adverse drug effects were noted. Conclusions In this case series of mostly community-acquired, lower extremity osteomyelitis, bone biopsy was infrequent, and an average six-week course of empiric ertapenem was well-tolerated with curative rates of 50% at one year.

  11. The Efficacy of Boric Acid Used to Treat Experimental Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus: an In Vivo Study.

    Science.gov (United States)

    Güzel, Yunus; Golge, Umut H; Goksel, Ferdi; Vural, Ahmet; Akcay, Muruvvet; Elmas, Sait; Turkon, Hakan; Unver, Ahmet

    2016-10-01

    We explored the ability of local and systemic applications of boric acid (BA) to reduce the numbers of methicillin-resistant Staphylococcus aureus (MRSA) in a rat model of tibial osteomyelitis (OM), and compared boric acid with vancomycin (V). Implant-associated osteomyelitis was established in 35 rats. After 4 weeks, at which time OM was evident both radiologically and serologically in all animals, the rats were divided into five groups of equal number: group 1, control group (no local application of BA or other medication); group 2, V group; group 3, local BA + V group; group 4, local BA group; and group 5, local + systemic BA group. Serum total antioxidant status, and the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6, were measured. Pathological changes attributable to bone OM were evaluated using a grading system. Bacterial colony-forming units (CFUs) per gram of bone were counted. The lowest bacterial numbers were evident in group 3, and the bacterial numbers were significantly lower than that of the control group in all four test groups (p < 0.001). Group 3 also had the least severe bone infection (OM score 1.7 ± 1.1, p < 0.05). Upon histological and microbiological evaluation, no significant difference was evident between groups 2 and 3. Total antioxidant levels were significantly different in all treatment groups compared to the control group. Microbiological and histopathological evaluation showed that systemic or local application of BA was effective to treat OM, although supplementary V increased the effectiveness of BA.

  12. Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

    Institute of Scientific and Technical Information of China (English)

    Brian; S; Pugmire; Randheer; Shailam; Michael; S; Gee

    2014-01-01

    Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging(MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical manage-ment. MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococ-cus aureus which have unique imaging features that are well-demonstrated with MRI. This review focuses primarily on the use of MRI in the evaluation of osteo-myelitis in children and will include a discussion of the clinically important and characteristic findings on MRI of acute bacterial osteomyelitis and related conditions.

  13. Osteomyelitis pubis caused by Kingella kingae in an adult patient: Report of the first case

    OpenAIRE

    Wilmes Dunja; Omoumi Patrick; Squifflet Jean; Cornu Olivier; Rodriguez-Villalobos Hector; Yombi Jean

    2012-01-01

    Abstract Background Kingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism. Case presentation We report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an ad...

  14. Current Understanding of the Pathogenesis and Management of Chronic Recurrent Multifocal Osteomyelitis

    OpenAIRE

    Ferguson, P. J.; M. Sandu

    2012-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder that primarily affects children. Its hallmark is recurring episodes of sterile osteomyelitis. The clinical presentation is insidious onset of bone pain with or without fever. Laboratory studies typically reveal nonspecific evidence of inflammation. Radiologic imaging and histologic appearance resemble those of infectious osteomyelitis. There is a strong association with inflammatory disorders of the skin and intesti...

  15. THE ANALYSIS OF THE DIABETIC FOOT OSTEOMYELITIS AT A TERTIARY CARE CENTER - A PROSPECTIVE STUDY

    OpenAIRE

    Mithun N; Pattanashetty; Reshmina; Sharath Babu; Harikrishna; Sreedhar Reddy; Ramakrishna J

    2015-01-01

    INTRODUCTION : India is considered as the diabetic capital of the world. Diabetic foot osteomyelitis is considered as one of the severe complications of diabetes mellitus. Diabetic foot osteomyelitis tends to complicate around one third of diabetic foot infections. In v iew of this we conducted a prospective study on the bacteriological analysis of diabetic foot osteomyelitis at a tertiary care center. MATERIALS AND METHODS : A prospective study was perform...

  16. Chronic recurrent multifocal osteomyelitis manifested as painful clavicular swelling: a case report

    OpenAIRE

    Bleckwenn, Markus; Sommer, Bernd; Weckbecker, Klaus

    2014-01-01

    Background Chronic recurrent multifocal osteomyelitis is a form of non-bacterial osteomyelitis which occurs primarily in childhood. In some cases painful bone swelling occurs. After a malignancy has been ruled out, antibiotic therapy is often started to treat the osteomyelitis. The course of this benign disease is self-limiting and is not positively affected by the antibiotic therapy. Case presentation A 14-year-old German girl from South Africa came to the surgery with painful swelling in th...

  17. A 73-Year-Old Male with Cervical Spine Osteomyelitis Presenting as Urosepsis.

    Science.gov (United States)

    Kakarlapudi, H; Speirs, S; Lal, A P; Alaie, D; Petrillo, R; Ashraf, M B; Kolanuvada, B; Bhargava, M

    2015-01-01

    Vertebral osteomyelitis is a serious debilitating infection if not detected early. Involvement of cervical vertebrae is usually seen in the presence of specific risk factors. Urinary tract infection commonly spreads to the lumbar vertebrae. This is a case presentation of an elderly male who, in the absence of specific risk factors for cervical osteomyelitis, presented with symptoms of urinary tract infection and was found to have cervical spine osteomyelitis.

  18. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review

    Energy Technology Data Exchange (ETDEWEB)

    Haliloglu, M. [Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Kleiman, M.B. [Dept. of Pediatrics, Indiana University School of Medicine, Indianapolis, IN (United States); Siddiqui, A.R. [Division of Nuclear Medicine, Indiana University School of Medicine, Indianapolis, IN (United States); Cohen, M.D. [Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)

    1994-09-01

    Acute pyogenic sacroiliac joint infection and osteomyelitis of adjacent bones often present with severe, poorly localized lower back, pelvic of hip pain. Five cases of sacroiliac joint infection or sacroiliac bone osteomyelitis were evaluated by MRI. MRI may be a helpful diagnostic tool to evaluate early changes of infection in the sacroiliac area. It is very sensitive for detecting bone marrow abnormalities; however, it is non-specific and can not accurately differentiate osteomyelitis from sacroiliitis. (orig.)

  19. Stress responses in the opportunistic pathogen Acinetobacter baumannii.

    Science.gov (United States)

    Fiester, Steven E; Actis, Luis A

    2013-03-01

    Acinetobacter baumannii causes a wide range of severe infections among compromised and injured patients worldwide. The relevance of these infections are, in part, due to the ability of this pathogen to sense and react to environmental and host stress signals, allowing it to persist and disseminate in medical settings and the human host. This review summarizes current knowledge on the roles that environmental and cellular stressors play in the ability of A. baumannii to resist nutrient deprivation, oxidative and nitrosative injury, and even the presence of the commonly used antiseptic ethanol, which could serve as a nutrient- and virulence-enhancing signal rather than just being a convenient disinfectant. Emerging experimental evidence supports the role of some of these responses in the pathogenesis of the infections A. baumannii causes in humans and its capacity to resist antibiotics and host response effectors.

  20. Current molecular methods in epidemiological typing of Acinetobacter baumannii.

    Science.gov (United States)

    Rafei, Rayane; Kempf, Marie; Eveillard, Matthieu; Dabboussi, Fouad; Hamze, Monzer; Joly-Guillou, Marie-Laure

    2014-01-01

    The emergence of Acinetobacter baumannii during recent decades as an important nosocomial pathogen responsible of worldwide, intensively documented, outbreaks has resulted in a need for effective epidemiological typing methods. Throughout the years, many typing methods for A. baumannii epidemiological studies have been proposed from phenotypic to molecular methods. Currently, the use of phenotypic typing methods have declined considerably and been progressively replaced by molecular methods. In this review, we introduce the current molecular methods available for A. baumannii typing. Each method has its own advantages and disadvantages, and the selection of an appropriate genotyping method depends on studied objectives. This review sheds light on questions in different epidemiological settings and most molecular methods used to fit these objectives.

  1. Locally advanced breast implant associated anaplastic large cell lymphoma: A case report of successful treatment with radiation and chemotherapy

    Directory of Open Access Journals (Sweden)

    Christopher Fleighton Estes

    2015-02-01

    Full Text Available The development of breast implant associated anaplastic large cell lymphoma (ALCL is a rare phenomenon. A typical presentation is an effusion associated with a breast implant. Less commonly, disease can become more advanced locoregionally or distantly. The optimal treatment schema is a topic of debate: localized ALCL can potentially be cured with implant removal alone, while other cases in the literature, including those that are more advanced, have been treated with varying combinations of surgery, chemotherapy, and external beam radiotherapy. This is a case report of breast implant ALCL with pathologically proven lymph node involvement, the fifth such patient reported. Our patient experienced a favorable outcome with radiation therapy and chemotherapy.

  2. MR findings of squamous cell carcinoma arising from chronic osteomyelitis of the tibia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Han, Dong Hwa; Lee, Ji Hae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Bae, Kyung Eun [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2016-05-15

    Malignant transformation is a rare and late complication of untreated chronic osteomyelitis. Known radiographic findings of the malignant transformation of chronic osteomyelitis are osteolytic or mixed sclerotic and osteolytic lesions with or without soft tissue mass. But its magnetic resonance (MR) imaging findings are rarely described in the literature. We experienced a case of an 82-year-old man diagnosed with squamous cell carcinoma arising from long standing chronic osteomyelitis of the tibia. Our case indicates that radiologists should consider the possibility of malignant transformation in patients with untreated chronic osteomyelitis, with enhancing soft tissue mass invading and extending through underlying bone cortex and medulla on MR imaging.

  3. Chronic Osteomyelitis in Sternum Mimicking Bone Metastasis of Lung Cancer Patient

    Energy Technology Data Exchange (ETDEWEB)

    Im, Hyung Jun; Kim, Yu Keong; Lee, Sang Mi; Lee, Won Woo; Kim, Sang Eun [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

    2009-06-15

    Primary sternal osteomyelitis without predisposing factors is a rare condition, and it is hardly differentiated from metastatic bone tumor especially in patient with the history of primary malignancy because osteomyelitis shares frequently common findings with metastatic bone lesion on {sup 18}F-FDG PET and bone scan. Although there have been several publications of primary osteomyelitis mimicking bone metastasis in the spine or extremities, we report a case of primary sternal osteomyelitis in the patient with lung cancer, which has, to our knowledge, not been reported before.

  4. Local osteogenic expression of cyclooxygenase-2 and systemic response in porcine models of osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, Louise K.; Iburg, Tine M.; Nielsen, Ole L.;

    2012-01-01

    It is suggested that cyclooxygenase 2 (COX-2) derived prostaglandins contributes to the progressive bone loss seen in osteomyelitis lesions. In the present study we examined the expression of COX-2 in bones from 23 pigs with experimental osteomyelitis. Osteomyelitis was induced with Staphylococcus...... in vivo study showing an early wave of COX-2 mediated bone resorption during osteomyelitis. Therefore, treatment aiming to reduce the break down of bone tissue directed by the COX-2 pathway might be suggested early in the course of the disease....

  5. Treatment of a chronic Scedosporium apiospermum vertebral osteomyelitis. Case report.

    Science.gov (United States)

    German, John W; Kellie, Susan M; Pai, Manjunath P; Turner, Paul T

    2004-12-15

    Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.

  6. Development of osteomyelitis secondary to a snakebite: Case Report

    Directory of Open Access Journals (Sweden)

    Bilsev Ince

    2016-09-01

    Full Text Available The Viperidae family is responsible for most of the venomous snakebites in Anatolia. Toxicity symptoms may be local such as edema, hyperemia, blisters, necrosis, lymphadenopathy, and ecchymosis or hematological, including high white blood cell (WBC, neutrophilia, decrease in hemoglobin, thrombocytopenia, international normalized ratio (INR elongation, and increase in creatine kinase (CK, tumor necrosis factor alpha (TNF and #945;, and lactate dehydrogenase (LDH. Antivenom thera- py should be provided if hyperemia continues and/or edema does not regress. Complications are very low in envenomation cases related to Viperidae bites with proper treatment and follow-up. Otherwise, complications can progress to necrosis, acute renal failure, compartment syndrome, amputation, and death may be seen. However, no report in the literature has described osteomyelitis as a late complication of snakebite. In this study, we present an osteomyelitis case caused by snakebite culminating in amputation because of the inadequate treatment. [Arch Clin Exp Surg 2016; 5(3.000: 180-183

  7. Salmonella newport causing osteomyelitis in a patient with diabetes.

    Science.gov (United States)

    Weston, Natasha; Moran, Ed

    2015-11-24

    Salmonella is a foodborne pathogen that commonly causes intestinal symptoms. Bacteraemia and extraintestinal infections have been documented within the literature, and are more frequently associated with immunodeficiency and general debilitation. We discuss the case of a previously well 36-year-old man who presented with a septic knee and new-onset diabetes. Imaging confirmed osteomyelitis and a Brodie's abscess, with blood and tissue cultures revealing the isolate Salmonella enterica newport. He denied any previous gastrointestinal symptoms, recent travel, change in usual dietary habit or symptoms of diabetes. So far there have only been three reported cases of S. newport causing osteomyelitis. We discuss the incidence of Salmonella infections, including extraintestinal symptoms, its relation to immunodeficiency and the disease burden of S. newport.

  8. Clinical Differences Between Monomicrobial and Polymicrobial Vertebral Osteomyelitis.

    Science.gov (United States)

    Issa, Kimona; Pourtaheri, Sina; Stewart, Tyler; Faloon, Michael; Sahai, Nikhil; Mease, Samuel; Sinha, Kumar; Hwang, Ki; Emami, Arash

    2016-11-11

    Little literature exists examining differences in presentation and outcomes between monomicrobial and polymicrobial vertebral infections. Seventy-nine patients treated for vertebral osteomyelitis between 2001 and 2011 were reviewed. Patients were divided into monomicrobial and polymicrobial cohorts based on type of infection. Various characteristics were compared between the 2 groups. The 26 patients with a polymicrobial infection were older and had a higher mortality rate, lower clearance of infection, larger infection, more vertebral instability, higher erythrocyte sedimentation rate at presentation, and longer mean length of stay. There were no significant differences in Oswestry Disability Index scores at final follow-up, but there were differences in presentation and clinical outcomes between monomicrobial and polymicrobial vertebral osteomyelitis. Patients may benefit from counseling regarding their disease type and potential prognosis. [Orthopedics. 201x; xx(x):xx-xx.].

  9. MORPHOLOGICAL EVALUATION OF CONSEQUENCES OF LONG BONE OSTEOMYELITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Y. E. Garkavenko

    2012-01-01

    Full Text Available The authors studied morphological changes in bone, cartilage and soft tissue from the zone of old inflammation and far from it in 36 children with pathological hip dislocation, in 23 - with limb shortening, in 13 - with pseudoarthrosis and long bone defects after osteomyelitis. Morphological assessment of proximal femur tissue in children, who had hematogenous osteomyelitis in early childhood, identified severe changes in cartilage and bone tissue which accompanied by muscle pathology. The state of the femoral head articular cartilage and acetabulum in patients with pathological hip dislocation is characterized by degenerative changes of varying severity (up to the formation of necrobiosis and necrosis focus, by the replacement of hyaline cartilage by tissue, formed by the type of fibrous cartilage and fibrous (scar tissue. This picture did not have significant differences depending on the osteomyelitis prescription. Directly in the area of the former inflammatory process, as well as in the ends of pseudoarthrosis bone fragments of long bone the degenerative changes of bone tissue with the signs of resorption and low-grade osteogenic activity are marked. The morphological texture of the femur diaphysis, located far from the old inflammation, did not differ from normal. It may indicate its potency for normal bone formation. Muscle tissue in the area of old inflammation keeps the signs of unevenly expressed degeneration and atrophy. Far from this zone muscle tissue doesn’t differ from its usual structure. The described morphological changes can serve as justification for the improvement of methods of surgical treatment in children with consequences of osteomyelitis.

  10. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Nirmal Raj Gopinathan

    2016-01-01

    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  11. Osteomyelitis variolosa with fracture: A unique case report

    Directory of Open Access Journals (Sweden)

    Pradeep K Singh

    2012-01-01

    Full Text Available Smallpox has been eradicated completely but its unique pathology and sequlae are still found in routine clinical practice. We present a report of a patient having osteomyelitis variolosa in both elbow joints and wrist with fracture of humerus. The condyles were typically elongated as central portion of distal humerus absorbed. The fracture united uneventfully following stabilization with dynamic compression plate and bone grafting. Patient had satisfactory elbow function at the end of the last follow-up.

  12. Diabetic foot complicated by vertebral osteomyelitis and epidural abscess

    OpenAIRE

    Alessandro Mantovani; Maddalena Trombetta; Chiara Imbriaco; Riccardo Rigolon; Lucia Mingolla; Federica Zamboni; Francesca Dal Molin; Dario Cioccoloni; Viola Sanga; Massimiliano Bruti; Enrico Brocco; Michela Conti; Giorgio Ravenna; Fabrizia Perrone; Vincenzo Stoico

    2016-01-01

    Summary Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement o...

  13. Osteomyelitis in the diabetic foot: diagnosis and management.

    Science.gov (United States)

    Game, Frances L

    2013-09-01

    Although osteomyelitis of the foot in diabetes remains common in specialist foot clinics across the world, the quality of published work to guide clinicians in the diagnosis and management is generally poor. Diagnosis should be based primarily on clinical signs supported by results of pathologic and radiologic investigations. Although the gold standard comes from the histologic and microbiological examination of bone, clinicians should be aware of the problems of sampling error. This lack of standardization of diagnostic criteria and of consensus on the choice of outcome measures poses further difficulties when seeking evidence to support management decisions. Experts have traditionally recommended surgical removal of infected bone but available evidence suggests that in many cases (excepting those in whom immediate surgery is required to save life or limb) a nonsurgical approach to management of osteomyelitis may be effective for many, if not most, patients with osteomyelitis of the diabetic foot. The benefits and limitations of both approaches need, however, to be established in prospective trials so that appropriate therapy can be offered to appropriate patients at the appropriate time, with the patients' views taken fully into account.

  14. Osteomyelitis diagnosis by {sup 99m}Tc radiolabeled aptamers

    Energy Technology Data Exchange (ETDEWEB)

    Santos, S.R.; Ferreira, I.M.; Andrade, A.S.R., E-mail: sararoberta7@hotmail.com, E-mail: imendesf@yahoo.com.br, E-mail: antero@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Barros, A.L.B.; Cardoso, V.N.; Diniz, O.F., E-mail: brancodebarros@yahoo.com.br, E-mail: valbertcardoso@yahoo.com.br, E-mail: simoneodilia@yahoo.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia. Departamento de Analises Clinicas e Toxicologicas

    2015-07-01

    Osteomyelitis, which is characterized by progressive inflammatory destruction and new opposition of bone, is still a difficult infection to treat. The clinical diagnosis in late stages is achieved easily, but an early diagnosis is more challenging. Staphylococcus aureus is a common agent found in osteomyelitis and bone prostheses infection. Diagnosis by scintigraphy has advantages because it is a non-invasive procedure and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis since specific radiopharmaceuticals were developed. In this study, aptamers selected to Staphylococcus aureus were labeled with {sup 99m}Tc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with {sup 99m}Tc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with {sup 99m}Tc was as control. Six animals were used in each group. The aptamers labeled with {sup 99m}Tc were able to identify the infection foci caused by S. aureus displaying a target/non-target ratio of 2,23 ± 0,20, after 3 h. The control group presented a target/non-target ratio 1,08 ± 0.23. The results indicated that the radiolabeled aptamers were able to identify specifically the infection foci and they should be further explored for infection diagnosis by scintigraphy. (author)

  15. Ultrasonographic findings of septic arthritis and osteomyelitis in neonatal hip

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hoon; Jung, Kun Sik; Koh, Jung Kon; Im, Myung Ah; Kwon, Kwi Ryun; Kim, Sung Soo [Pohang Sunlim Hospital, Handong University, Pohang (Korea, Republic of)

    2000-06-15

    To evaluate ultrasonographic findings of neonatal patients who confirmed and treated as hip joint septic arthritis and osteomyelitis. We retrospectively examined clinical feature and radiologic findings of 7 neonatal patients ranging from 8 to 28 days of age who were examined from January 1966 to December 1998 at nursery and were confirmed and treated on the diagnosis of septic arthritis and osteomyelitis. Clinical features of the patients were comparatively analyzed with radiologic findings including plain radiographs, ultrasonography, bone scan and MRI. We emphasized importance of ultrasonographic findings of these patients. Ultrasonography was performed first of all in all cases after the symptom onset. Other examinations were performed on the same day or a few days later after ultrasonography. Ultrasonography revealed abnormal finding in 85.7% (6/7) of all cases. Plain radiographs revealed abnormal findings in 28.6% (2/7). Bone scan revealed decreased uptake in 66.7%(2/3). MRI revealed abnormal signal intensity in 100%(3/3). Ultrasonographic findings of the patients were deep soft swelling in 85.7% (6/7) of all cases, periosteal elevation in 57.1% (4/7), synovial thickening in 42.8% (3/7), synovial effusion in 42.8%(3/7), echogenic debris or clot in 28.5% (2/7), cortical erosion in 28.5% (2/7), and subperiosteal abscess in 14.2% (1/7). Ultrasonography is a useful modality to diagnose septic arthritis and osteomyelitis in neonatal hip.

  16. A systematic review of animal models for Staphylococcus aureus osteomyelitis

    Directory of Open Access Journals (Sweden)

    W Reizner

    2014-03-01

    Full Text Available Staphylococcus aureus (S. aureus osteomyelitis is a significant complication for orthopaedic patients undergoing surgery, particularly with fracture fixation and arthroplasty. Given the difficulty in studying S. aureus infections in human subjects, animal models serve an integral role in exploring the pathogenesis of osteomyelitis, and aid in determining the efficacy of prophylactic and therapeutic treatments. Animal models should mimic the clinical scenarios seen in patients as closely as possible to permit the experimental results to be translated to the corresponding clinical care. To help understand existing animal models of S. aureus, we conducted a systematic search of PubMed and Ovid MEDLINE to identify in vivo animal experiments that have investigated the management of S. aureus osteomyelitis in the context of fractures and metallic implants. In this review, experimental studies are categorised by animal species and are further classified by the setting of the infection. Study methods are summarised and the relevant advantages and disadvantages of each species and model are discussed. While no ideal animal model exists, the understanding of a model’s strengths and limitations should assist clinicians and researchers to appropriately select an animal model to translate the conclusions to the clinical setting.

  17. Management of sternal osteomyelitis and mediastinal infection following median sternotomy

    Institute of Scientific and Technical Information of China (English)

    GAO Ju; WANG Wen-zhang; WANG You-li; LU Shu-qiang; CAI Ai-bing; YANG Zhi-fu; HAN Zhi-yi; LI Jiu-jiang; WEN Yu-ming; GENG Feng-yong

    2010-01-01

    Background Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy.Methods Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.Results No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.Conclusions Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged stermal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

  18. A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    Haruka Miyabe

    2016-01-01

    Full Text Available Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

  19. Epigenetic Modification Mediates the Increase of LAG-3(+) T Cells in Chronic Osteomyelitis.

    Science.gov (United States)

    Wang, Yicun; Wang, Jun; Meng, Jia; Jiang, Hui; Zhao, Jianning; Qian, Hongbo; Chen, Tao

    2016-12-27

    Immune suppression plays critical roles in the development of chronic osteomyelitis, and the mechanisms underlying the development of immune suppression in chronic osteomyelitis have attracted much attention. LAG-3 is an important suppressor of T cell activation, but the role of LAG-3 in the immune regulation of chronic osteomyelitis is currently unknown. We sought to demonstrate if LAG-3 plays crucial roles in chronic osteomyelitis progression and has effects on immune suppression and exhausting of T cells, and what is the mechanism underlying LAG-3 deregulation in chronic osteomyelitis. We examined the expression of LAG-3 in the T cells of peripheral blood of 50 healthy controls and 50 patients with chronic osteomyelitis by flow cytometry. Clinical data were analyzed to determine the correlation between inflammation index and LAG-3 expression. Moreover, we isolated the CD4(+) T cells from healthy controls and chronic osteomyelitis patients to compare cell proliferation and IFN-γ production. Chromatin immunoprecipitation assays were utilized to analyze the epigenetic modification on LAG-3 expression in T cells. We found that LAG-3 was significantly increased in the T cells of peripheral blood from chronic osteomyelitis patients. Subsequently, clinical data analysis suggested that the higher expression of LAG-3 was associated with severer inflammation situation. Consistently, LAG-3(+)CD4(+) T cells exhibited impaired cell proliferation and IFN-γ secretion. Deregulation of histone methylation mediated the increase of LAG-3(+) T cells during chronic osteomyelitis. Taken together, our study demonstrates the increase of LAG-3(+) T cells and its immune regulatory roles in chronic osteomyelitis progression, suggesting new mechanisms and potential therapeutic targets for chronic osteomyelitis.

  20. Contribution of Reduced Interleukin-10 Levels to the Pathogenesis of Osteomyelitis in Children with Sickle Cell Disease.

    Science.gov (United States)

    Sarray, Sameh; Almawi, Wassim Y

    2015-09-01

    Osteomyelitis is a significant complication of sickle cell disease (SCD), and several factors contribute to its pathogenesis, including altered expression of proinflammatory and anti-inflammatory cytokines. In view of the role of interleukin-10 (IL-10) as an anti-inflammatory cytokine, we tested the notion that SCD osteomyelitis is associated with a reduction in IL-10 secretion and, hence, precipitation of a proinflammatory state. Study subjects comprised 52 SCD patients with confirmed diagnosis of osteomyelitis and 165 age- and gender-matched SCD patients with negative histories of osteomyelitis. Results obtained showed that IL-10 serum levels in SCD osteomyelitis patients were significantly lower than those of control SCD patients. Receiver operating characteristic (ROC) analysis demonstrated that altered IL-10 serum levels predicted the development of osteomyelitis, and the mean area under ROC curves of IL-10 was 0.810 among SCD patients with osteomyelitis. A systematic shift in IL-10 serum levels toward lower values was seen in osteomyelitis cases, with an increased osteomyelitis risk associated with decreased IL-10 levels. Multivariate logistic regression analyses confirmed the independent association of reduced IL-10 with osteomyelitis after controlling for sickle hemoglobin (HbS), fetal hemoglobin (HbF), platelet count, and white blood cell (WBC) count. These data support the strong association of decreased IL-10 levels with osteomyelitis, thereby supporting a role for IL-10 in osteomyelitis follow-up.

  1. Confronting multidrug-resistant Acinetobacter baumannii: a review.

    Science.gov (United States)

    Neonakis, Ioannis K; Spandidos, Demetrios A; Petinaki, Efthimia

    2011-02-01

    Multidrug-resistant Acinetobacter baumannii (MDR-AB) infections are difficult to treat owing to the extremely limited armamentarium. The present review reports all available treatment options against MDR-AB, including single molecules, combination schemes, and alternative modes of antimicrobial administration. Additionally, a group of recently reported peptides with anti-MDR-AB activity is described.

  2. First steps towards a vaccine against Acinetobacter baumannii.

    Science.gov (United States)

    Garcia-Quintanilla, Meritxell; Pulido, Marina R; McConnell, Michael J

    2013-01-01

    Acinetobacter baumannii has become an important cause of human infections, most notably in the hospital setting. In addition, the global dissemination of multidrug resistant strains has complicated effective antibiotic therapy of infections produced by this pathogen, necessitating the development of novel treatment and prevention strategies. Active and passive immunization approaches have begun to be explored in experimental animal models as potential alternative therapies for A. baumannii. In the present review, we discuss the advantages and disadvantages of each therapeutic strategy with respect to A. baumannii infections, and summarize the recent studies that have explored these approaches. The single antigen candidates that have been tested include, the outer membrane protein OmpA, the membrane transporter Ata, the biofilm-associated protein Bap, the K1 capsular polysaccharide and the membrane associated polysaccharide poly-N-acetyl-β -(1-6)-glucosamine. Strategies employing multicomponent antigens include inactivated whole cells, outer membrane complexes and outer membrane vesicles. The strengths and limitations of each approach are discussed and the challenges that remain to be addressed for successful A. baumannii vaccine development are highlighted.

  3. Tetracyclines for multidrug-resistant Acinetobacter baumannii infections.

    Science.gov (United States)

    Falagas, Matthew E; Vardakas, Konstantinos Z; Kapaskelis, Anastasios; Triarides, Nikolaos A; Roussos, Nikolaos S

    2015-05-01

    Multidrug-resistant (MDR) Acinetobacter baumannii infections have emerged as a serious threat worldwide. As novel agents have yet to be developed, understanding the effectiveness and safety of older antibiotics has become a priority. The purpose of this systematic review was to summarise the available clinical evidence on the use of tetracyclines for the treatment of A. baumannii infections. Ten retrospective studies regarding doxycycline and minocycline for the treatment of 185 A. baumannii infections (of which 65.4% were respiratory infections and 13% were bloodstream infections) in 156 patients were available. In most cases (86.4%), tetracyclines were administered in combination with another agent. The usual dosage of doxycycline or minocycline was 100mg intravenous or per os twice daily (usually with a 200mg loading dose for minocycline). Clinical success was achieved in 120 (76.9%) of 156 patients; in 87 (71.9%) of 121 respiratory infections and in 21 (87.5%) of 24 bloodstream infections. Twenty-two deaths occurred in 100 recorded cases. Microbiological eradication was attained in 72 (71.3%) of 101 available cases and documented microbiological eradication was reached in 59 (66.3%) of 89 available cases. Adverse events were noted in only 1 of 88 cases. Overall, although tetracycline-containing regimens showed encouraging results, more data from larger comparative trials are required to establish a role for these antibiotics in the treatment of MDR A. baumannii infections.

  4. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

    Science.gov (United States)

    Seng, Piseth; Alliez, Antoine; Honnorat, Estelle; Menard, Amelie; Casanova, Dominique; Stein, Andreas

    2014-01-01

    Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France. PMID:26793446

  5. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

    Directory of Open Access Journals (Sweden)

    Piseth Seng

    2015-01-01

    Full Text Available Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France.

  6. Bone scintigraphy for neonatal osteomyelitis: simulation by extravasation of intravenous calcium

    Energy Technology Data Exchange (ETDEWEB)

    Balsam, D.; Goldfarb, C.R.; Stringer, B.; Farruggia, S.

    1980-04-01

    Intravenously administered calcium gluconate has become increasingly popular in the treatment of neonatal tetany. Occasionally, extravasation results in cellulitis, leading to a clinical diagnosis of superimposed osteomyelitis. Osseous scintigraphy, as the accepted modality in the early detection of osteomyelitis, would tend to be used in this circumstance. This case illustrates a false-positive result, probably due to soft-tissue calcification.

  7. Role of computed tomography and radionuclide scintigraphy in the localization of osteomyelitis in flat bones

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez, R.J.; Conway, J.J.; Poznanski, A.K.; Tachdjian, M.O.; Dias, L.S.; Kelikian, A.S.

    1985-03-01

    The combined use of radionuclide scintigraphy and computed tomography is recommended for evaluating children with laboratory and clinical data suggestive of flat bone osteomyelitis despite normal conventional radiographs. In addition, computed tomography may be helpful in the presence of abnormal radiographs in determining the exact location of the focus of osteomyelitis and the most suitable route for appropriate drainage or to obtain culture material.

  8. Risk factors for developing osteomyelitis in patients with diabetic foot wounds

    NARCIS (Netherlands)

    Lavery, Lawrence A.; Peters, Edgar J. G.; Armstrong, David G.; Wendel, Christopher S.; Murdoch, Douglas P.; Lipsky, Benjamin A.

    2009-01-01

    Aims: Osteomyelitis worsens the prognosis in the diabetic foot, but predisposing factors remain largely undefined, In a prospectively followed cohort we assessed risk factors for developing osteomyelitis. Methods: We enrolled consecutive persons with diabetes who presented to a managed-care diabetes

  9. Streptococcus viridans osteomyelitis and endocarditis following dental treatment: a case report

    OpenAIRE

    Choudhury, Maitrayee; Patel, Brijesh R; Patel, Minal; Bashir, Tariq

    2009-01-01

    Vertebral osteomyelitis is an uncommon complication of infective endocarditis with the organism Streptococcus viridans being a rare cause of the condition. This case highlights an unusual presentation of Streptococcus viridans associated with infective endocarditis and pyogenic osteomyelitis in a patient following a dental procedure.

  10. Low-cost antibiotic delivery system for the treatment of osteomyelitis in developing countries

    NARCIS (Netherlands)

    Rasyid, Hermawan Nagar

    2009-01-01

    Although application of biomaterials has been one of the major assets in modern medicine to improve the quality of life of patients, occurrence of a chronic osteomyelitis is still a serious health threat to the individual patient. Chronic osteomyelitis can result in morbidity affecting the viability

  11. Prediction of the course of acute odontogenic pathology with pronounced osteomyelitis by immunoglobulin and cytokin evaluation

    Directory of Open Access Journals (Sweden)

    A. I. Yaremenko

    2013-01-01

    Full Text Available The aim of our trial was detection of the most significant clinico-laboratory factors in the saliva and blood samples of the patients with odontogenic osteomyelitis in order to predict severity of the clinical course of osteomyelitis and to choose the optimal treatment tactics.

  12. A history of osteomyelitis from the Journal of Bone and Joint Surgery: 1948 TO 2006.

    Science.gov (United States)

    Klenerman, L

    2007-05-01

    Osteomyelitis is one of the oldest diseases known. It took many years before the acute infection could be brought under control with antibiotics and chronic osteomyelitis remains difficult to manage. The modern history of the disease is reflected in the pages of the Journal of Bone and Joint Surgery.

  13. [Current approaches to explain the virulence of Acinetobacter baumannii].

    Science.gov (United States)

    Aşık, Gülşah

    2011-04-01

    Acinetobacter baumannii which is one of the most frequent nosocomial pathogens, has drawn attention in the last years owing to multi-drug resistant strains. A.baumannii may give rise to nosocomial epidemics especially in intensive care units and may lead to treatment failure due to its increasing antimicrobial resistance. These gram-negative non-fermentative coccobacilli may be encountered also in community associated infections. However, they are frequently isolated in pneumonia, urinary tract infection, bacteremia, meningitis and wound infections that develop in patients hospitalized for serious diseases. Although detailed data about the epidemiology and antimicrobial resistance patterns related to this bacteria exist, relatively limited data is present about the virulence factors and environmental physiology of A.baumannii. The role of some bacterial virulence factors in the pathogenesis of Acinetobacter infections have been enlightened by recent investigations. Among these virulence factors, production of extracellular enzymes with lipolytic and cytolytic activities, outer membrane protein (AbOmpA) with apoptotic effects on epithelial cells, adhesion molecules (fimbria and AbOmpA) that function during attachment to epithelial cells, K1 type capsular structure, type-1 pili and AbOmpA induced biofilm formation, siderophore (acinetobactin) or hemin mediated iron acquisition mechanisms, quorum sensing system that functions by the help of N-acyl homoserine lacton signal molecules and cellular components that enable Acinetobacter species to live under inappropriate environmental conditions like dryness, low temperature, restricted nutritional elements, can be counted. New information about the virulence factors will help better understanding of the adaptive response of A.baumannii in the host setting. This review is focused on the current information about the virulence factors of of A.baumannii.

  14. Subacute, tetracycline-responsive, granulomatous osteomyelitis in an adult man, consistent with Q fever infection.

    Science.gov (United States)

    Bayard, Cornelia; Dumoulin, Alexis; Ikenberg, Kristian; Günthard, Huldrych F

    2015-12-09

    Osteomyelitis due to Coxiella burnetii infection is a rare condition in adults. We report the case of a healthy young man presenting with subacute osteomyelitis of the left cheek bone, evolving gradually after an episode of acute febrile illness. Histological evaluation confirmed subacute granulomatous inflammation. Despite antibody titres not reaching the standard cut-off for chronic Q fever (phase I IgG 1/160, phase II IgG 1/2560), osteomyelitis was radiologically and histologically confirmed. A 6-month course of doxycycline/hydroxychloroquine brought clinical and radiological cure while various conventional antibiotic treatments had failed to improve the clinical condition. Currently, at 6-month follow-up, no relapse has occurred and antibody titres have declined. A shorter course of doxycycline/hydroxychloroquine than that used for chronic Q fever osteomyelitis may be sufficient to treat subacute Q fever osteomyelitis in some cases.

  15. Comparative Genomic Analysis of Rapid Evolution of an Extreme-Drug-Resistant Acinetobacter baumannii Clone

    DEFF Research Database (Denmark)

    Tan, Sean Yang-Yi; Chua, Song Lin; Liu, Yang

    2013-01-01

    , comparative genomics has been employed to analyze the rapid evolution of an EDR Acinetobacter baumannii clone from the intensive care unit (ICU) of Rigshospitalet at Copenhagen. Two resistant A. baumannii strains, 48055 and 53264, were sequentially isolated from two individuals who had been admitted to ICU...... within a 1-month interval. Multilocus sequence typing indicates that these two isolates belonged to ST208. The A. baumannii 53264 strain gained colistin resistance compared with the 48055 strain and became an EDR strain. Genome sequencing indicates that A. baumannii 53264 and 48055 have almost identical...... genomes—61 single-nucleotide polymorphisms (SNPs) were found between them. The A. baumannii 53264 strain was assembled into 130 contigs, with a total length of 3,976,592 bp with 38.93% GC content. The A. baumannii 48055 strain was assembled into 135 contigs, with a total length of 4,049,562 bp with 39...

  16. Prevalence of antibiotic resistance among Acinetobacter baumannii isolates from Aleppo, Syria.

    Science.gov (United States)

    Hamzeh, Abdul Rezzak; Al Najjar, Mona; Mahfoud, Maysa

    2012-10-01

    This study describes and analyzes Acinetobacter baumannii antibiotic susceptibly profile in Aleppo, Syria, thus providing vital information for guiding treatment of A baumannii infections. Two hundred sixty nonrepetitive A baumannii isolates were studied over 3.5 years. Resistance rates are at the higher end of globally reported levels. Newer cephalosporins and β-lactamase-resistant agents are becoming practically ineffective. Better activity is limited to carbapenems and colistin, which elicited the highest susceptibility levels.

  17. Peritoneal Dialysis-Related Peritonitis with Acinetobacter baumannii: A Review of Seven Cases

    OpenAIRE

    Zhang, Wei; Wu, Yong-Gui; Qi, Xiang-Ming; Dai, Hong; Lu, Wen; Zhao, Min

    2014-01-01

    Peritonitis is still known as an important complication of continuous ambulatory peritoneal dialysis (CAPD). Multi-drug resistant (MDR) Acinetobacter baumannii is an increasing problem worldwide. Moreover, the increasing reports of carbapenem-resistant A. baumannii strains is common. Although peritoneal dialysis-related peritonitis with MDR A. baumannii is rarely reported, infection with this organism always results in serious peritonitis and increases the possibility of dropout or mortality....

  18. Draft Genome Sequences of Acinetobacter baumannii Isolates from Wounded Military Personnel.

    Science.gov (United States)

    Arivett, Brock A; Ream, Dave C; Fiester, Steven E; Kidane, Destaalem; Actis, Luis A

    2016-08-25

    Acinetobacter baumannii is a Gram-negative bacterium capable of causing hospital-acquired infections that has been grouped with Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species as ESKAPE pathogens because of their extensive drug resistance phenotypes and increasing risk to human health. Twenty-four multidrug-resistant A. baumannii strains isolated from wounded military personnel were sequenced and annotated.

  19. Antimicrobial Resistance of Acinetobacter baumannii to Imipenem in Iran: A Systematic Review and Meta-Analysis

    OpenAIRE

    Pourhajibagher, Maryam; Hashemi, Farhad B.; POURAKBARI, Babak; Aziemzadeh, Masoud; Bahador, Abbas

    2016-01-01

    Imipenem-resistant multi-drug resistant (IR-MDR) Acinetobacter baumannii has been emerged as a morbidity successful nosocomial pathogen throughout the world.To address imipenem being yet the most effective antimicrobial agent against A. baumannii to control outbreaks and treat patients, a systematic review and meta-analysis was performed to evaluate the prevalence of IR-MDR A. baumannii. We systematically searched Web of Science, PubMed, MEDLINE, Science Direct, EMBASE, Scopus, Cochrane Libra...

  20. Acinetobacter baumannii Septicemia in a Recipient of an Allogeneic Hematopoietic Stem Cell Transplantation

    Science.gov (United States)

    Al-Anazi, Khalid Ahmed; Abdalhamid, Baha; Alshibani, Zeyad; Awad, Khalid; Alzayed, Abdullah; Hassan, Hoda; Alsayiegh, Mohammed

    2012-01-01

    Acinetobacter baumannii is a gram-negative, nonfermentative coccobacillus that causes infections in immunocompromised and chronically ill patients and is associated with multidrug resistance. Two days before receiving her nonmyeloablative stem cell allograft, a patient with acute myeloid leukemia developed Acinetobacter baumannii bacteremia that caused septic shock which was successfully treated with imipenem and removal of the central venous catheter. To our knowledge, this is the first report of Acinetobacter baumannii septicemia in a hematopietic stem cell transplantation recipient. PMID:23259136

  1. Interaction of Acinetobacter baumannii 19606 and 1656-2 with Acanthamoeba castellanii.

    Science.gov (United States)

    Tamang, Migma Dorji; Kim, Shukho; Kim, Sung-Min; Kong, Hyun-Hee; Kim, Jungmin

    2011-10-01

    Acinetobacter baumannii is virtually avirulent for healthy people but maintains a high virulence among critically ill patients or immuno-compromised individuals. The ability of A. baumannii to adhere to cells and persist on surfaces as biofilms could be central to its pathogenicity. In the present study, we compared the virulence of the A. baumannii 1656-2 clinical strain, which is able to form a thick biofilm, with the virulence of the A. baumannii type strain (ATCC 19606(T)). Acanthamoeba castellanii, a single-celled organism, was used as the host model system to study the virulence of A. baumannii. Compared to A. baumannii ATCC 19606(T), A. baumannii 1656-2 exhibited a higher ability to adhere and invade A. castellanii cells and had a higher killing rate of A. castellanii cells. Furthermore, co-incubation of the amoeba cells and the cell-free supernatant of A. baumannii resulted in the cell death of the amoebae. Heat inactivation or proteinase K treatment of the supernatant did not eliminate its cytotoxicity, suggesting heat stable non-protein factors are responsible for its cytotoxicity to A. castellanii cells. In conclusion, this study for the first time has revealed the capacity of the A. baumannii strain and/or its metabolic products to induce cytotoxicity in A. castellanii cells.

  2. Inactivation of Acinetobacter baumannii Biofilms on Polystyrene, Stainless Steel, and Urinary Catheters by Octenidine Dihydrochloride

    Science.gov (United States)

    Narayanan, Amoolya; Nair, Meera S.; Karumathil, Deepti P.; Baskaran, Sangeetha A.; Venkitanarayanan, Kumar; Amalaradjou, Mary Anne Roshni

    2016-01-01

    Acinetobacter baumannii is a major nosocomial pathogen causing human infections with significant mortality rates. In most cases, infections are acquired through exposure to A. baumannii biofilms that persist on contaminated hospital equipment and surfaces. Thus, it is imperative to develop effective measures for controlling A. baumannii biofilms in nosocomial settings. This study investigated the efficacy of octenidine dihydrochloride (OH), a new generation disinfectant for reducing A. baumannii biofilms on polystyrene, stainless steel and catheters. OH at 0.3% (5 mM), 0.6% (10 mM), and 0.9% (15 mM) was effective in significantly inactivating A. baumannii biofilms on all tested surfaces (P < 0.05). Furthermore, OH was equally effective in inactivating biofilms of multidrug resistant and drug susceptible A. baumannii isolates. In addition, confocal imaging revealed the predominance of dead cells in the OH-treated samples in comparison to the control. Further, scanning electron microscopy of biofilms formed on catheters revealed that OH treatment significantly reduced A. baumannii biofilm populations in corroboration with our antibiofilm assay. These data underscore the efficacy of OH in inactivating A. baumannii biofilms, thereby suggesting its potential use as a disinfectant or a catheter lock solution to control A. baumannii infections. PMID:27375572

  3. Inactivation of Acinetobacter baumannii Biofilms on Polystyrene, Stainless Steel, and Urinary Catheters by Octenidine Dihydrochloride.

    Science.gov (United States)

    Narayanan, Amoolya; Nair, Meera S; Karumathil, Deepti P; Baskaran, Sangeetha A; Venkitanarayanan, Kumar; Amalaradjou, Mary Anne Roshni

    2016-01-01

    Acinetobacter baumannii is a major nosocomial pathogen causing human infections with significant mortality rates. In most cases, infections are acquired through exposure to A. baumannii biofilms that persist on contaminated hospital equipment and surfaces. Thus, it is imperative to develop effective measures for controlling A. baumannii biofilms in nosocomial settings. This study investigated the efficacy of octenidine dihydrochloride (OH), a new generation disinfectant for reducing A. baumannii biofilms on polystyrene, stainless steel and catheters. OH at 0.3% (5 mM), 0.6% (10 mM), and 0.9% (15 mM) was effective in significantly inactivating A. baumannii biofilms on all tested surfaces (P < 0.05). Furthermore, OH was equally effective in inactivating biofilms of multidrug resistant and drug susceptible A. baumannii isolates. In addition, confocal imaging revealed the predominance of dead cells in the OH-treated samples in comparison to the control. Further, scanning electron microscopy of biofilms formed on catheters revealed that OH treatment significantly reduced A. baumannii biofilm populations in corroboration with our antibiofilm assay. These data underscore the efficacy of OH in inactivating A. baumannii biofilms, thereby suggesting its potential use as a disinfectant or a catheter lock solution to control A. baumannii infections.

  4. Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy

    Directory of Open Access Journals (Sweden)

    Warmuth-Metz Monika

    2007-01-01

    Full Text Available Abstract Background Hypophosphatasia (HP is characterized by a genetic defect in the tissue-nonspecific alkaline phosphatase (TNSALP gene and predominantly an autosomal recessive trait. HP patients suffer from reduced bone mineralization. Biochemically, elevated concentrations of substrates of TNSALP, including pyridoxal-5'-phosphate and inorganic pyrophosphate occur in serum, tissues and urine. The latter has been associated with chronic inflammation and hyperprostaglandinism. Case presentation We report on 2 affected children presenting with multifocal inflammatory bone lesions mimicking malignancy: A 6 years old girl with short stature had been treated with human growth hormone since 6 months. Then she started to complain about a painful swelling of her left cheek. MRI suggested a malignant bone lesion. Bone biopsy, however, revealed chronic inflammation. A bone scan showed a second rib lesion. Since biopsy was sterile, the descriptive diagnosis of chronic non-bacterial osteomyelitis (CNO was established. The diagnostic tests related to growth failure were repeated and subsequent analyses demonstrated a molecular defect in the TNSALP gene. The second girl (10 years old complained about back pain after she had fallen from her bike. X rays of her spine revealed compressions of 2 thoracic vertebrae. At first these were considered trauma related, however a bone scan did show an additional lesion in the right 4th rib. A biopsy of this rib revealed a sterile lympho- plasmocytoid osteomyelitis suggesting multifocal CNO. Further analyses did show a decreased TNSALP in leukocytes and elevated pyridoxal phosphate in plasma, suggesting a heterozygous carrier status of HP. Conclusion Chronic bone oedema in adult HP and chronic hyper-prostaglandinism in childhood HP do suggest that in some HP patients bone inflammation is present in conjunction with the metabolic defect. Sterile multifocal osteomyelitis could be demonstrated. Non-steroidal anti

  5. Clinical and tomography evolution of frontal osteomyelitis: Case report

    Directory of Open Access Journals (Sweden)

    Raquel Crisóstomo Lima Verde1, , , , ,

    2012-01-01

    Full Text Available Introduction: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

  6. Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana

    Directory of Open Access Journals (Sweden)

    de Farias Marconi

    2012-12-01

    Full Text Available Abstract Background Nocardiosis is an unusual infection in companion animals characterized by suppurative to pyogranulomatous lesions, localized or disseminated. Cutaneous-subcutaneous, pulmonary and systemic signs are observed in feline nocardiosis. However, osteomyelitis is a rare clinical manifestation in cats. Nocardia cyriacigeorgica (formerly N. asteroides sensu stricto, Nocardia brasiliensis, Nocardia otitidiscaviarum, and Nocardia nova are the most common pathogenic species identified in cats, based on recent molecular classification (16S rRNA gene. The present report is, to our knowledge, the first case of mandibular osteomyelitis in a cat caused by Nocardia africana, diagnosed based upon a combination of methods, including molecular techniques. Case presentation A one-year-old non-neutered female cat, raised in a rural area, was admitted to the Companion Animal Hospital-PUCPR, São José dos Pinhais, State of Paraná, Brazil, with a history a progressive facial lesion, difficulty apprehending food, loss of appetite, apathy and emaciation. Clinical examination showed fever, submandibular lymphadenitis, and a painless, 8 cm diameter mass, which was irregularly-shaped, of firm consistency, and located in the region of the left mandible. The skin around the lesion was friable, with diffuse inflammation (cellulitis, multiple draining sinuses, and exudation of serosanguinous material containing whitish “sulfur” granules. Diagnosis was based initially in clinical signs, microbiological culture, cytological, and histopathological findings, and radiographic images. Molecular sequencing of 16S rRNA of isolate allowed diagnosis of Nocardia africana. Despite supportive care and antimicrobial therapy based on in vitro susceptibility testing the animal died. Conclusion The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological

  7. The surgical treatment of chronic recurrent hematogenous osteomyelitis in children

    Directory of Open Access Journals (Sweden)

    Sukhrob Zayniev

    2013-04-01

    Full Text Available The results of surgical treatment of 178 patients with chronic recurrent osteomyelitis of the tube bones have been analyzed. It has been proposed the tactic of surgical treatment consisting of the tear of tissues for a distance of the diaphysis of the affected bone, cautious periosteum exfoliation from the bone, longitudinal osteotomy, sequestrnecrectomy with full restoration structure of intramedullary canal along the whole length, lavage and ultrasound cavitation with antiseptic solution. The performed surgical tactic secured the most radical sanation of the osteomyelitic focus and improved the treatment results of this severe pathology.

  8. Chronic sternal osteomyelitis complicating primary manubriosternal septic arthritis.

    Science.gov (United States)

    Sinha, S; Sinha, A; Nagarajah, K; Oei, E L; Critchley, P; McNally, M A

    2006-11-01

    We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.

  9. Pyogenic spinal osteomyelitis: a review of 61 cases.

    Science.gov (United States)

    Silverthorn, K G; Gillespie, W J

    1986-02-12

    The presentation and outcome of 61 cases of nontuberculous spinal osteomyelitis were reviewed. Although the commonest presentation was subacute, with back pain predominating, 10% had septicaemia and 7% paraperesis or paraplegia. Most infections were caudal to the fourth thoracic vertebra. One third were associated with preceding urinary, respiratory, dental or abdominal sepsis. Staphylococcus aureus was the infecting organism in 85% of isolates. Delay in diagnosis was frequent. There were four deaths, and seven individuals remained severely disabled: outcome was otherwise satisfactory. An algorithm for the investigation and management of this uncommon but serious condition is proposed.

  10. Sclerosing osteomyelitis of Garré periostitis ossificans.

    Science.gov (United States)

    Belli, Evaristo; Matteini, Claudio; Andreano, Tiziana

    2002-11-01

    Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.

  11. Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

    Directory of Open Access Journals (Sweden)

    Kaur M

    2015-10-01

    Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

  12. Confronting a dramatic situation: the charcot foot complicated by osteomyelitis.

    Science.gov (United States)

    Dalla Paola, Luca

    2014-12-01

    Charcot osteoarthropathy is a serious complication of diabetic neuropathy. Its prevalence in the diabetic population varies in the literature in relation to certain variables, such as the method of assessment, clinical or instrumental; the population studied; and the scope of the selection. This article is intended as a review of the recent literature concerning Charcot osteoarthropathy in its evolution and complications characterized by the development of ulceration and subsequent bone infection. Diagnosis and treatment strategies--either medical or surgical--are discussed both for Charcot arthropathy and osteomyelitis.

  13. Osteomyelitis in leukocyte adhesion deficiency type 1 syndrome

    DEFF Research Database (Denmark)

    Jabbari Azad, Farahzad; Ardalan, Maryam; H.Rafati, Ali;

    2010-01-01

    Leukocyte adhesion deficiency type 1 (LAD-1) is a rare, inherited immunodeficiency that affects one per million people yearly and usually presents with recurrent, indolent bacterial infections of the skin, mouth, and respiratory tract and impaired pus formation and wound healing. A 13-year-old gi......(10.60%). A plain radiography of the left leg revealed osteomyelitis. It is highly suggested that patients diagnosed mild to moderate LAD-1 with recurrent skin infection and simultaneous weak response to conventional therapy undergo (BMT) marrow transplant to prohibit subsequent life...

  14. Clinical outcomes of osteomyelitis patients infected with methicillin-resistant Staphylococcus aureus USA-300 strains.

    Science.gov (United States)

    Peyrani, P; Allen, M; Seligson, D; Roberts, C; Chen, A; Haque, N; Zervos, M; Wiemken, T; Harting, J; Christensen, D; Ramirez, R

    2012-03-01

    Methicillin-resistant Staphylococcus aureus (MRSA) USA-300 strains have emerged as an important cause of community-acquired infections. These strains have been recognized as an etiology of osteomyelitis but data on their incidence and outcomes are limited. We retrospectively studied the incidence and clinical outcomes of MRSA USA-300 osteomyelitis in patients at the University of Louisville Hospital and the Henry Ford Health System between January 2007 and March 2008. Pulsed-field gel electrophoresis was used to determine USA type. Clinical outcomes were defined as management success versus failure at 12 months. Chi-square tests, Fisher exact tests, and Mann-Whitney tests were used to compare patient characteristics on the basis of clinical outcomes and USA type. Of the 50 patients with MRSA osteomyelitis, 27 (54%) had the USA-300 strain. Clinical failure was identified in 22% (6/27) of the patients with MRSA USA-300 and in 30% (7/23) of the patients with MRSA non-USA-300 osteomyelitis (P = .509). Our results showed that MRSA USA-300 is a significant etiology of MRSA osteomyelitis. With current surgical and medical management, outcomes of patients with MRSA USA-300 osteomyelitis are similar to those of patients with MRSA non-USA-300 osteomyelitis.

  15. Mesenchymal stromal cell implantation for stimulation of long bone healing aggravates Staphylococcus aureus induced osteomyelitis.

    Science.gov (United States)

    Seebach, Elisabeth; Holschbach, Jeannine; Buchta, Nicole; Bitsch, Rudi Georg; Kleinschmidt, Kerstin; Richter, Wiltrud

    2015-07-01

    Large bone defects requiring long-term osteosynthetic stabilization or repeated surgeries show a considerable rate of infection. Mesenchymal stromal cells (MSCs) have been successfully used to enhance bone regeneration, but their powerful immunomodulatory effects may impose an enhanced risk for osteomyelitis development. In order to unravel whether implantation of MSCs aggravates a simultaneous bone infection, a hydrogel-supported osteomyelitis ostectomy model was developed in which rats received a femoral bone defect with rigid plate-fixation. After fibrin-assisted transfer of Staphylococcus aureus (SA), effects of MSC implantation on osteomyelitis development were quantified over 3-4 weeks. All SA-infected animals developed an acute local osteomyelitis with significantly increased blood neutrophil count, abscess formation and bone destruction. MSC-treatment of infected defects aggravated osteomyelitis according to a significantly elevated osteomyelitis score and enhanced distal bone loss with spongy alteration of cortical bone architecture. Increased attraction of macrophages, osteoclasts and regulation of pro- and anti-inflammatory mediators were potential MSC actions. Overall trophic actions of MSCs implanted into non-sterile bone defects may enhance an infection and/or exacerbate osteomyelitis. Studies on antibiotic carrier augmentation or antibiotic treatment are warranted to decide whether MSC implantation is a safe and promising therapy for orthopedic implant-stabilized bone defects at high risk for development of infection.

  16. Characterization of newly isolated lytic bacteriophages active against Acinetobacter baumannii.

    Science.gov (United States)

    Merabishvili, Maia; Vandenheuvel, Dieter; Kropinski, Andrew M; Mast, Jan; De Vos, Daniel; Verbeken, Gilbert; Noben, Jean-Paul; Lavigne, Rob; Vaneechoutte, Mario; Pirnay, Jean-Paul

    2014-01-01

    Based on genotyping and host range, two newly isolated lytic bacteriophages, myovirus vB_AbaM_Acibel004 and podovirus vB_AbaP_Acibel007, active against Acinetobacter baumannii clinical strains, were selected from a new phage library for further characterization. The complete genomes of the two phages were analyzed. Both phages are characterized by broad host range and essential features of potential therapeutic phages, such as short latent period (27 and 21 min, respectively), high burst size (125 and 145, respectively), stability of activity in liquid culture and low frequency of occurrence of phage-resistant mutant bacterial cells. Genomic analysis showed that while Acibel004 represents a novel bacteriophage with resemblance to some unclassified Pseudomonas aeruginosa phages, Acibel007 belongs to the well-characterized genus of the Phikmvlikevirus. The newly isolated phages can serve as potential candidates for phage cocktails to control A. baumannii infections.

  17. The structure of alanine racemase from Acinetobacter baumannii.

    Science.gov (United States)

    Davis, Emily; Scaletti-Hutchinson, Emma; Opel-Reading, Helen; Nakatani, Yoshio; Krause, Kurt L

    2014-09-01

    Acinetobacter baumannii is an opportunistic Gram-negative bacterium which is a common cause of hospital-acquired infections. Numerous antibiotic-resistant strains exist, emphasizing the need for the development of new antimicrobials. Alanine racemase (Alr) is a pyridoxal 5'-phosphate dependent enzyme that is responsible for racemization between enantiomers of alanine. As D-alanine is an essential component of the bacterial cell wall, its inhibition is lethal to prokaryotes, making it an excellent antibiotic drug target. The crystal structure of A. baumannii alanine racemase (AlrAba) from the highly antibiotic-resistant NCTC13302 strain has been solved to 1.9 Å resolution. Comparison of AlrAba with alanine racemases from closely related bacteria demonstrates a conserved overall fold. The substrate entryway and active site of the enzymes were shown to be highly conserved. The structure of AlrAba will provide the template required for future structure-based drug-design studies.

  18. In vitro activity of ceftobiprole against Acinetobacter baumannii clinical isolates.

    Science.gov (United States)

    Marti, Sara; Sánchez-Céspedes, Javier; Espinal, Paula; Vila, Jordi

    2009-09-01

    Acinetobacter baumannii is a multiresistant opportunistic nosocomial pathogen responsible for outbreaks worldwide. The main infection caused by this microorganism is nosocomial pneumonia, in particular ventilator-associated pneumonia in patients in Intensive Care Units. Treatment of these nosocomial infections is becoming problematic because the level of resistance to antimicrobial agents is rising. Ceftobiprole is a new cephalosporin with activity against Gram-positive and Gram-negative pathogens. This study evaluated the in vitro activity of ceftobiprole against a collection of 58 A. baumannii clinical isolates and showed that the activity of ceftobiprole was superior to ceftazidime and cefepime when the bla(ADC)-like gene was not expressed or was expressed at a low level.

  19. Characterization of newly isolated lytic bacteriophages active against Acinetobacter baumannii.

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    Maia Merabishvili

    Full Text Available Based on genotyping and host range, two newly isolated lytic bacteriophages, myovirus vB_AbaM_Acibel004 and podovirus vB_AbaP_Acibel007, active against Acinetobacter baumannii clinical strains, were selected from a new phage library for further characterization. The complete genomes of the two phages were analyzed. Both phages are characterized by broad host range and essential features of potential therapeutic phages, such as short latent period (27 and 21 min, respectively, high burst size (125 and 145, respectively, stability of activity in liquid culture and low frequency of occurrence of phage-resistant mutant bacterial cells. Genomic analysis showed that while Acibel004 represents a novel bacteriophage with resemblance to some unclassified Pseudomonas aeruginosa phages, Acibel007 belongs to the well-characterized genus of the Phikmvlikevirus. The newly isolated phages can serve as potential candidates for phage cocktails to control A. baumannii infections.

  20. [Ecological aspects and prophylaxis of Acinetobacter baumannii nosocomial infection].

    Science.gov (United States)

    Boukadida, J

    2000-01-01

    Acinetobacter Baumannii is an aerobic strit gram negative bacteria cause of epidemic infection in intensive care units this bacteria is isolated from the patient and its environment. The detection of AB infection require the isolation of patients and decontamination of the material despite the virulence of the germ, these measures are necessary due to the rapid extension of epidemic in the absence of adequate means.

  1. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii.

    Science.gov (United States)

    Lob, Sibylle H; Hoban, Daryl J; Sahm, Daniel F; Badal, Robert E

    2016-04-01

    Acinetobacter baumannii, although representing a small percentage of Gram-negative bacilli isolates in intra-abdominal infections (IAIs) and urinary tract infections (UTIs), is frequently multidrug-resistant (MDR) and can pose difficult therapeutic challenges. From 2011 to 2014, 2337 A. baumannii were collected from IAIs and UTIs at 453 hospital sites in 48 countries as part of the SMART ongoing surveillance initiative. Current susceptibility and multidrug resistance, defined as resistance to at least three of the tested drug classes, were determined in a subset of 1011 isolates from 2013 to 2014. A. baumannii comprised 0.7-4.6% of all aerobic and facultative Gram-negative bacilli isolated in six global regions. MDR rates were lowest in North America (47%) and highest in Europe and the Middle East (>93%), with higher rates in ICUs than in non-ICU wards in almost all regions. Antimicrobial susceptibility profiles varied by region but resistance was high everywhere, with no drug inhibiting >70% of A. baumannii isolates in any region. Susceptibility to imipenem was highest in North America (64%) and lowest in Europe and the Middle East (≤11%). Amikacin overall was the most active of the studied agents, including against MDR isolates (of which 11-38% were susceptible). Trend analysis of only those countries that contributed isolates in each study year (2011-2014) demonstrated an increasing trend in MDR rates in the Middle East as well as decreasing susceptibility to several single antimicrobial agents in Africa, Europe and the Middle East. These patterns and trends can help direct antimicrobial therapy and infection control efforts.

  2. Treatment of osteomyelitis with antibiotic-soaked porous glass ceramic.

    Science.gov (United States)

    Kawanabe, K; Okada, Y; Matsusue, Y; Iida, H; Nakamura, T

    1998-05-01

    We have developed a new drug delivery system using porous apatite-wollastonite glass ceramic (A-W GC) to treat osteomyelitis. A-W GC (porosity, 70% and 20% to 30%), or porous hydroxyapatite (HA) blocks (porosity 35% to 48%) used as controls, were soaked in mixtures of two antibiotics, isepamicin sulphate (ISP) and cefmetazole (CMZ) under high vacuum. We evaluated the release concentrations of the antibiotics from the blocks. The bactericidal concentration of ISP from A-W GC was maintained for more than 42 days, but that from HA decreased to below the detection limit after 28 days. The concentrations of CMZ from both materials were lower than those of ISP. An in vivo study using rabbit femora showed that an osseous concentration of ISP was maintained at eight weeks after implantation. Osteoconduction of the A-W GC block was good. Four patients with infected hip arthroplasties and one with osteomyelitis of the tibia have been treated with the new delivery system with excellent results.

  3. Kingella kingae infections in paediatric patients: 5 cases of septic arthritis, osteomyelitis and bacteraemia.

    Science.gov (United States)

    Birgisson, H; Steingrimsson, O; Gudnason, T

    1997-01-01

    Kingella kingae is a Gram-negative rod most often recognized as 1 of the organisms causing septic arthritis and osteomyelitis in children. Infection caused by K. kingae had not been diagnosed in Iceland until 5 cases were diagnosed at the Paediatric Department at the University Hospital of Iceland over a 1 year period. In this report we describe these 5 children with invasive infection caused by K. kingae (2 with septic arthritis, 1 with osteomyelitis, 1 with septic arthritis and osteomyelitis, and 1 with bacteraemia) and review the literature. All bacterial isolates were identified by the Bactec culture system.

  4. Osteomyelitis due to Bacillus cereus in an adolescent: case report and review.

    Science.gov (United States)

    Schricker, M E; Thompson, G H; Schreiber, J R

    1994-06-01

    Non-anthracis Bacillus species associated with clinical infections are usually dismissed as contaminants or nonpathogens. As opportunists, however, Bacillus organisms can cause significant systemic infections including bacteremia, endophthalmitis, and pneumonia. Osteomyelitis with non-anthracis Bacillus organisms has been described in adults, although to our knowledge it has been described only once in a child. We report a case of chronic osteomyelitis due to Staphylococcus aureus and superinfection with Bacillus cereus in a 13-year-old adolescent. A Bacillus isolate should be considered a true pathogen in children with chronic osteomyelitis who have a poor clinical response to antistaphylococcal therapy.

  5. Periostitis ossificans (Garrè′s osteomyelitis: An unusual case

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    Deepesh Singh

    2015-01-01

    Full Text Available Garrè′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè′s osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

  6. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem.

    Science.gov (United States)

    Ertugrul, Bulent M; Lipsky, Benjamin A; Savk, Oner

    2013-11-05

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  7. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    Directory of Open Access Journals (Sweden)

    Bulent M. Ertugrul

    2013-11-01

    Full Text Available Both osteomyelitis and Charcot neuro-osteoarthropathy (CN are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  8. Tuberculous osteomyelitis of the maxilla: A rarest of rare case report

    Science.gov (United States)

    Gupta, Ramesh; Garg, Meenu; Gupta, Ajay Kumar; Anand, C.

    2014-01-01

    Tuberculosis is a chronic granulomatous systemic infectious disease caused by Mycobacterium tuberculosis. The oral lesions found in tuberculosis are relatively rare and may present as ulcers, erythematous patches, indurated lesions, nodules or as bony jaw lesions. Oral tubercular lesions sometimes present a confusing clinical presentation and can be overlooked. Hence, we document a case of tuberculous osteomyelitis of the maxilla in a 19-year-old female patient, who was initially treated for multiple periodontal dental abscesses, which later proved to be tubercular osteomyelitis of the maxilla. Although it is a rare occurrence, the differential diagnosis of tuberculous osteomyelitis must always be considered when it fails to respond to routine therapy. PMID:25937732

  9. Acute osteomyelitis, septic arthritis and discitis: Differences between neonates and older children

    Energy Technology Data Exchange (ETDEWEB)

    Offiah, A.C. [Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH (United Kingdom)]. E-mail: offiaa@gosh.nhs.uk

    2006-11-15

    There are aetiological, clinical, radiological and therapeutic differences between musculoskeletal infection in the neonate (and infant) and in older children and adults. Due to the anatomy and blood supply in neonates, osteomyelitis often co-exists with septic arthritis. Discitis is more common in infants whereas vertebral body infection is more common in adults. This review article discusses the important clinical and radiological differences that in the past have led many authors to consider neonatal osteomyelitis a separate entity from osteomyelitis in the older child.

  10. Mycotic osteomyelitis due to Scedosporium Apiospermum: MR imaging-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Sydnor, Malcolm K.; Knight, Thomas E. [Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, P. O. Box 980615, Richmond, 23298-0615, VA (United States); Kaushik, Shaifali [Department of Radiology, VA Medical Center, 100 Emancipation Drive, 23667, Hampton, VA (United States); Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, P. O. Box 980615, Richmond, 23298-0615, VA (United States); Bridges, C.Lee [Department of Pathology, Medical College of Virginia Hospital, Virginia Commonwealth University, P.O. Box 980662, Richmond, 23298-0662, VA (United States); McCarty, John M. [Department of Internal Medicine, Medical College of Virginia Hospital, Virginia Commonwealth University, P.O. Box 980157, Richmond, 23298-0662, VA (United States)

    2003-11-01

    Mycotic osteomyelitis is rare and occurs in immunocompromised patients after inoculation of the pathogen at a penetrating trauma site. Mycotic osteomyelitis due to Scedosporium Apiospermum is extremely rare, with only 13 cases of septic arthritis reported previously. Ours is only the third case of S. apiospermum osteomyelitis in an immunocompromised patient and the only patient with a histopathologic diagnosis from an amputation specimen. Recognition of this pathogen may be delayed due to insidious onset and negative joint fluid cultures, often requiring synovial or bone biopsies to establish the diagnosis. Delay in appropriate treatment may result in disseminating infection or even death. (orig.)

  11. Congenital Insensitivity to Pain with Anhidrosis (CIPA Manifested with Chronic Osteomyelitis; A Case Report

    Directory of Open Access Journals (Sweden)

    Fatih Kucukdurmaz

    2014-03-01

    Full Text Available      Chronic osteomyelitis is a very rare entity among children. Also congenital insensitivity to pain with anhidrosis (CIPA is a very rare autosomal-recessive disease  of the nervous system which is one of the hereditary sensory and autonomic neuropathies (HSAN. Loss of pain, fever due to anhidrosis, recurrent fractures, chronic osteomyelitis, mental retardation, self mutilation, wound ulcers can be seen. We present a 10-year-old boy with loss of generalized pain sensation, chronic osteomyelitis on his right distal femur, bilateral corneal opacities, and decreased mental capacity.

  12. Pregnancy and Perinatal Outcomes Associated with Acinetobacter baumannii Infection

    Directory of Open Access Journals (Sweden)

    Mai He

    2013-05-01

    Full Text Available Objective - To determine perinatal and pregnancy outcomes of Acinetobacter baumannii infection using clinicopathologic material from pregnant women, neonates, and perinatal postmortem examinations with positive cultures. Study Design - This is a retrospective record review with placental and postmortem examination. Results - During a 5-year period, 40 positive cultures were found. Three pregnancies with positive cultures close in the peripartum period were all associated with adverse outcomes including spontaneous abortion, preterm labor, and one full-term birth with histological chorioamnionitis. Two positive cultures were found in preterm neonates in the neonatal intensive care unit. Two of three cases of perinatal death grew pure cultures from blood and/or fetal tissue with placental or fetal examination demonstrating evidence of infection/inflammation with fetal inflammatory response. Conclusion - This is the first case series report of A. baumannii-positive cultures in maternal, fetal, and neonatal specimen, with histopathologic evidence of infection. The results suggest a significant role of A. baumannii infection in adverse pregnancy and perinatal outcomes.

  13. Antimicrobial active herbal compounds against Acinetobacter baumannii and other pathogens.

    Science.gov (United States)

    Tiwari, Vishvanath; Roy, Ranita; Tiwari, Monalisa

    2015-01-01

    Bacterial pathogens cause a number of lethal diseases. Opportunistic bacterial pathogens grouped into ESKAPE pathogens that are linked to the high degree of morbidity, mortality and increased costs as described by Infectious Disease Society of America. Acinetobacter baumannii is one of the ESKAPE pathogens which cause respiratory infection, pneumonia and urinary tract infections. The prevalence of this pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source and resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. The high level of acquired and intrinsic carbapenem resistance mechanisms acquired by these bacteria makes their eradication difficult. The pharmaceutical industry has no solution to this problem. Hence, it is an urgent requirement to find a suitable alternative to carbapenem, a commonly prescribed drug for Acinetobacter infection. In order to do this, here we have made an effort to review the active compounds of plants that have potent antibacterial activity against many bacteria including carbapenem resistant strain of A. baumannii. We have also briefly highlighted the separation and identification methods used for these active compounds. This review will help researchers involved in the screening of herbal active compounds that might act as a replacement for carbapenem.

  14. Antimicrobial active herbal compounds against Acinetobacter baumannii and other pathogens

    Directory of Open Access Journals (Sweden)

    Vishvanath eTiwari

    2015-06-01

    Full Text Available Bacterial pathogens cause a number of lethal diseases. Opportunistic bacterial pathogens grouped into ESKAPE pathogens that are linked to the high degree of morbidity, mortality and increased costs as described by Infectious Disease Society of America. Acinetobacter baumannii is one of the ESKAPE pathogens which cause respiratory infection, pneumonia and urinary tract infections. The prevalence of this pathogen increases gradually in the clinical setup where it can grow on artificial surfaces, utilize ethanol as a carbon source and resists desiccation. Carbapenems, a β-lactam, are the most commonly prescribed drugs against A. baumannii. The high level of acquired and intrinsic carbapenem resistance mechanisms acquired by these bacteria makes their eradication difficult. The pharmaceutical industry has no solution to this problem. Hence, it is an urgent requirement to find a suitable alternative to carbapenem, a commonly prescribed drug for Acinetobacter infection. In order to do this, here we have made an effort to review the active compounds of plants that have potent antibacterial activity against many bacteria including carbapenem resistant strain of A. baumannii. We have also briefly highlighted the separation and identification methods used for these active compounds. This review will help researchers involved in the screening of herbal active compounds that might act as a replacement for carbapenem.

  15. Stereochemical insignificance discovered in Acinetobacter baumannii quorum sensing.

    Directory of Open Access Journals (Sweden)

    Amanda L Garner

    Full Text Available Stereochemistry is a key aspect of molecular recognition for biological systems. As such, receptors and enzymes are often highly stereospecific, only recognizing one stereoisomer of a ligand. Recently, the quorum sensing signaling molecules used by the nosocomial opportunistic pathogen, Acinetobacter baumannii, were identified, and the primary signaling molecule isolated from this species was N-(3-hydroxydodecanoyl-L-homoserine lactone. A plethora of bacterial species have been demonstrated to utilize 3-hydroxy-acylhomoserine lactone autoinducers, and in virtually all cases, the (R-stereoisomer was identified as the natural ligand and exhibited greater autoinducer activity than the corresponding (S-stereoisomer. Using chemical synthesis and biochemical assays, we have uncovered a case of stereochemical insignificance in A. baumannii and provide a unique example where stereochemistry appears nonessential for acylhomoserine lactone-mediated quorum sensing signaling. Based on previously reported phylogenetic studies, we suggest that A. baumannii has evolutionarily adopted this unique, yet promiscuous quorum sensing system to ensure its survival, particularly in the presence of other proteobacteria.

  16. Acinetobacter baumannii in Localised Cutaneous Mycobacteriosis in Falcons

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    Margit Gabriele Muller

    2010-01-01

    Full Text Available Between May 2007 and April 2009, 29 falcons with identically localized, yellowish discolored cutaneous lesions in the thigh and lateral body wall region were presented at Abu Dhabi Falcon Hospital. Out of 18 falcons integrated in this study, 16 tested positive to Mycobacterium. avium complex. The 2 negative falcons tested positive in the Mycobacterium genus PCR. Moreover, 1 falcon tested positive to M. avium. paratuberculosis in tissue samples by PCR. In all cases, blood and fecal samples tested negative. In the acid-fast stain, all samples showed the for mycobacteriosis typical rods. Moreover, in 13 samples Acinetobacter baumannii was detected by PCR and proven by DNA sequencing. Clinical features included highly elevated WBCs, heterophilia, lymphocytopenia, monocytosis, severe anemia and weight loss. A. baumannii, a gram-negative bacillus with the ability to integrate foreign DNA, has emerged as one of the major multidrug resistant bacteria. In veterinary medicine, it has so far been detected in dogs, cats, horses and wild birds. To the authors' knowledge, this is the first report of an A. baumannii infection in falcons and of a veterinary Mycobacterium-Acinetobacter coinfection.

  17. Multidrug resistant Acinetobacter baumannii in veterinary medicine--emergence of an underestimated pathogen?

    Science.gov (United States)

    Müller, Stefanie; Janssen, Traute; Wieler, Lothar H

    2014-01-01

    The proportion of multidrug resistant bacteria causing infections in animals has continuously been increasing. While the relevance of ESBL (extended spectrum beta-lactamase)-producing Enterobacteriaceae spp. and MRSA (methicillin resistant Staphylococcus aureus) is unquestionable, knowledge about multidrug resistant Acinetobacter baumannii in veterinary medicine is scarce. This is a worrisome situation, as A. baumannii are isolated from veterinary clinical specimens with rising frequency. The remarkable ability of A. baumannii to develop multidrug resistance and the high risk of transmission are known in human medicine for years. Despite this, data regarding A. baumannii isolates of animal origin are missing. Due to the changing role of companion animals with closer contact between animal and owner, veterinary intensive care medicine is steadily developing. It can be assumed that the number of "high risk" patients with an enhanced risk for hospital acquired infections will be rising simultaneously. Thus, development and spread of multidrug resistant pathogens is envisioned to rise. It is possible, that A. baumannii will evolve into a veterinary nosocomial pathogen similar to ESBL-producing Enterobacteriaceae and MRSA. The lack of attention paid to A. baumannii in veterinary medicine is even more worrying, as first reports indicate a transmission between humans and animals. Essential questions regarding the role of livestock, especially as a potential source of multidrug resistant isolates, remain unanswered. This review summarizes the current knowledge on A. baumannii in veterinary medicine for the first time. It underlines the utmost significance of further investigations of A. baumannii animal isolates, particularly concerning epidemiology and resistance mechanisms.

  18. Draft Genome of the Multidrug-Resistant Acinetobacter baumannii Strain A155 Clinical Isolate.

    Science.gov (United States)

    Arivett, Brock A; Fiester, Steven E; Ream, David C; Centrón, Daniela; Ramírez, Maria S; Tolmasky, Marcelo E; Actis, Luis A

    2015-03-26

    Acinetobacter baumannii is a bacterial pathogen with serious implications on human health, due to increasing reports of multidrug-resistant strains isolated from patients. Total DNA from the multidrug-resistant A. baumannii strain A155 clinical isolate was sequenced to greater than 65× coverage, providing high-quality contig assemblies.

  19. Blood stream infections caused by Acinetobacter baumannii group in Japan - Epidemiological and clinical investigation.

    Science.gov (United States)

    Fujikura, Yuji; Yuki, Atsushi; Hamamoto, Takaaki; Kawana, Akihiko; Ohkusu, Kiyofumi; Matsumoto, Tetsuya

    2016-06-01

    Acinetobacter calcoaceticus-Acinetobacter baumannii complex, especially A. baumannii, Acinetobacter pittii and Acinetobacter nosocomialis, constitutes an important group of nosocomial pathogens; however, epidemiological or clinical characteristics and prognosis is limited in Japan. From 2009 to 2013, 47 blood stream infection cases resulting from A. baumannii group were reviewed at the National Defense Medical College, an 800-bed tertiary hospital. To determine the genospecies, further comparative nucleotide sequence analyses of the RNA polymerase b-subunit (rpoB) gene were performed. Sequence analysis of rpoB gene showed that 25 (49.0%), 17 (33.3%) and 5 (9.8%) cases were caused by A. baumannii, A. pittii and A. nosocomialis, respectively. The 30-day and in-hospital mortality rates of A. baumannii were 8.5% and 25.5%, respectively, and there were no significant differences between Acinetobacter species. Clinical characteristics were statistically insignificant. Multidrug-resistant Acinetobacter species were detected in 3 cases (5.9%) with same pulsed-field gel electrophoresis (PFGE) pattern and A. baumannii was less susceptible to amikacin and levofloxacin. In this study, the mortality and clinical characteristics were similar among A. baumannii group isolate cases despite some showing drug resistance. However, identification of Acinetobacter species helps to initiate appropriate antibiotic therapy in earlier treatment phase, because A. baumannii shows some drug resistance.

  20. Cryo-electron tomography analysis of membrane vesicles from Acinetobacter baumannii ATCC19606(T)

    NARCIS (Netherlands)

    Koning, Roman I.; de Breij, Anna; Oostergetel, Gert T.; Nibbering, Peter H.; Koster, Abraham J.; Dijkshoorn, Lenie

    2013-01-01

    Acinetobacter baumannii is an important nosocomial pathogen responsible for colonization and infection of critically ill patients. Its virulence attributes together with the condition of the host determine the pathogenicity of A. baumannii. These virulence factors may be delivered to host cells by m

  1. Towards an explanation for the success of Acinetobacter baumannii in the human host

    NARCIS (Netherlands)

    Breij, Anastasia (Anna)

    2012-01-01

    Acinetobacter baumannii is an important nosocomial pathogen responsible for outbreaks of infection worldwide. The studies presented in this thesis aimed to gain further insight into the bacterial and host factors associated with the pathogenesis of A. baumannii to seek an explanation for the clinica

  2. Multidrug resistant Acinetobacter baumannii reaches a new frontier: prosthetic hip joint infection.

    Science.gov (United States)

    Hischebeth, G T R; Wimmer, M D; Molitor, E; Seifert, H; Gravius, S; Bekeredjian-Ding, I

    2015-02-01

    Acinetobacter baumannii is an emerging nosocomial pathogen primarily in countries with a high prevalence of multidrug resistance. Here we report the detection of a bla OXA23 carbapenemase-producing A. baumannii strain in a German patient with prosthetic hip joint infection following several hip joint surgeries but no history of foreign travel.

  3. Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis.

    Science.gov (United States)

    van Vugt, T A G; Geurts, J; Arts, J J

    2016-01-01

    Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

  4. Peritoneal dialysis-related peritonitis with Acinetobacter baumannii: a review of seven cases.

    Science.gov (United States)

    Zhang, Wei; Wu, Yong-Gui; Qi, Xiang-Ming; Dai, Hong; Lu, Wen; Zhao, Min

    2014-05-01

    Peritonitis is still known as an important complication of continuous ambulatory peritoneal dialysis (CAPD). Multi-drug resistant (MDR) Acinetobacter baumannii is an increasing problem worldwide. Moreover, the increasing reports of carbapenem-resistant A. baumannii strains is common. Although peritoneal dialysis-related peritonitis with MDR A. baumannii is rarely reported, infection with this organism always results in serious peritonitis and increases the possibility of dropout or mortality. Here, we present 7 cases of peritonitis caused by A. baumannii species. Among those 7 cases, 2 involved MDR A. baumannii, and 1 involved a carbapenem-resistant strain. All the MDR bacterial infections failed treatment. We also review the literature about Acinetobacter peritonitis and current treatment protocols.

  5. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options

    Science.gov (United States)

    Lee, Chang-Ro; Lee, Jung Hun; Park, Moonhee; Park, Kwang Seung; Bae, Il Kwon; Kim, Young Bae; Cha, Chang-Jun; Jeong, Byeong Chul; Lee, Sang Hee

    2017-01-01

    Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized. PMID:28348979

  6. Toll-Like Receptor 9 Contributes to Defense against Acinetobacter baumannii Infection.

    Science.gov (United States)

    Noto, Michael J; Boyd, Kelli L; Burns, William J; Varga, Matthew G; Peek, Richard M; Skaar, Eric P

    2015-10-01

    Acinetobacter baumannii is a common nosocomial pathogen capable of causing severe diseases associated with significant morbidity and mortality in impaired hosts. Pattern recognition receptors, such as the Toll-like receptors (TLRs), play a key role in pathogen detection and function to alert the immune system to infection. Here, we examine the role for TLR9 signaling in response to A. baumannii infection. In a murine model of A. baumannii pneumonia, TLR9(-/-) mice exhibit significantly increased bacterial burdens in the lungs, increased extrapulmonary bacterial dissemination, and more severe lung pathology compared with those in wild-type mice. Following systemic A. baumannii infection, TLR9(-/-) mice have significantly increased bacterial burdens in the lungs, as well as decreased proinflammatory cytokine and chemokine production. These results demonstrate that TLR9-mediated pathogen detection is important for host defense against the opportunistic pathogen Acinetobacter baumannii.

  7. Effects of silver nanoparticles in combination with antibiotics on the resistant bacteria Acinetobacter baumannii.

    Science.gov (United States)

    Wan, Guoqing; Ruan, Lingao; Yin, Yu; Yang, Tian; Ge, Mei; Cheng, Xiaodong

    2016-01-01

    Acinetobacter baumannii resistance to carbapenem antibiotics is a serious clinical challenge. As a newly developed technology, silver nanoparticles (AgNPs) show some excellent characteristics compared to older treatments, and are a candidate for combating A. baumannii infection. However, its mechanism of action remains unclear. In this study, we combined AgNPs with antibiotics to treat carbapenem-resistant A. baumannii (aba1604). Our results showed that single AgNPs completely inhibited A. baumannii growth at 2.5 μg/mL. AgNP treatment also showed synergistic effects with the antibiotics polymixin B and rifampicin, and an additive effect with tigecyline. In vivo, we found that AgNPs-antibiotic combinations led to better survival ratios in A. baumannii-infected mouse peritonitis models than that by single drug treatment. Finally, we employed different antisense RNA-targeted Escherichia coli strains to elucidate the synergistic mechanism involved in bacterial responses to AgNPs and antibiotics.

  8. Spontaneous kyphotic collapse followed by autostabilisation secondary to cervical osteomyelitis in an intravenous drug abuser.

    Science.gov (United States)

    Arun, Ranganathan; Kasbekar, Anand Vijay; Mehdian, S M Hossein

    2007-12-01

    There is a high risk of cervical osteomyelitis in intravenous drug abusers due to the use of jugular veins for administration of drugs. Here described is a case of rapid vertebral body destruction at two levels leading to a progressive kyphotic deformity followed by autofusion, secondary to cervical osteomyelitis. The case report goes on to hypothesise about the unique manner of progression of untreated cervical osteomyelitis with a rapid onset of kyphotic deformity and associated severe bone destruction in an intravenous drug abuser. Due to the high incidence of osteomyelitis in intravenous drug abusers, there should be a low threshold to investigate for this condition and early magnetic resonance imaging is vital. It alerts the treating spine surgeon to the fact that early immobilisation is crucial in these cases to prevent a severe impending deformity that can be surgically challenging.

  9. Extra-osseous fat fluid level: a specific sign for osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, Jyoti; Bandhu, Suman; Kumar, Atin [All India Institute of Medical Sciences, Department of Radiology, New Delhi (India); Alam, Shah [All India Institute of Medical Sciences, Department of Orthopedics, New Delhi (India)

    2007-06-15

    Osteomyelitis may pose as a diagnostic dilemma on various imaging modalities and may be confused with neoplasms and other pathology. Although a rare finding, extra-osseous fat fluid level, especially when associated with spongy bone destruction, can be considered a specific sign of osteomyelitis. Previously, only two cases of extra-osseous fat fluid level in osteomyelitis have been reported, one on computed tomography (CT) and the other on magnetic resonance imaging (MRI). The former was a case of septic arthritis with intra-articular fat fluid level. A case of osteomyelitis is presented with the demonstration of extra-osseous fat fluid level. Our case is unique in providing exquisite CT and MRI correlation. (orig.)

  10. Thoracolumbar Scoliosis Due to Cryptococcal Osteomyelitis: A Case Report and Review of the Literature.

    Science.gov (United States)

    Li, Zheng; Liang, Jinqian; Shen, Jianxiong; Qiu, Guixing; Weng, Xisheng

    2016-02-01

    Cryptococcus neoformans causes opportunistic infections in immunocompromised patients, with vertebral osteomyelitis being a very rare involvement.This study is to present a case of thoracolumbar scoliosis occurring in the setting of cryptococcal osteomyelitis.Pharmacological intervention with anticryptococcal medicine and medical management of immune hemolytic anemia were administered. After initial acute stabilization, she underwent spinal debridement and fusion on October 29, 2008. She eventually recovered fully from this episode with no subsequent mechanical instability or neurological deficits on subsequent clinic follow-ups.To the best of our knowledge, there have been no reports describing the onset of spinal cryptococcal osteomyelitis along with immune hemolytic anemia. We suggest a comprehensive algorithm for the diagnosis of vertebral cryptococcal osteomyelitis.

  11. Candida spp. airway colonization: A potential risk factor for Acinetobacter baumannii ventilator-associated pneumonia.

    Science.gov (United States)

    Tan, Xiaojiang; Zhu, Song; Yan, Dongxing; Chen, Weiping; Chen, Ruilan; Zou, Jian; Yan, Jingdong; Zhang, Xiangdong; Farmakiotis, Dimitrios; Mylonakis, Eleftherios

    2016-08-01

    This retrospective study was conducted to identify potential risk factors for Acinetobacter baumannii (A. baumannii) ventilator-associated pneumonia (VAP) and evaluate the association between Candida spp. airway colonization and A. baumannii VAP. Intensive care unit (ICU) patients who were on mechanical ventilation (MV) for ≥48 hours were divided into the following groups: patients with and without Candida spp. airway colonization; colonized patients receiving antifungal treatment or not; patients with A. baumannii VAP and those without VAP. Logistic regression analysis and propensity score matching were used to identify factors independently associated with A. baumannii VAP. Among 618 eligible patients, 264 (43%) had Candida spp. airway colonization and 114 (18%) developed A. baumannii VAP. Along with MV for ≥7 days (adjusted odds ratio [aOR] 8.9, 95% confidence intervals [95% CI] 4.9-15.8) and presence of a central venous catheter (aOR 3.2, 95% CI 1.1-9), Candida spp. airway colonization (aOR 2.6, 95% CI 1.6-4.3) was identified as an independent risk factor for A. baumannii VAP. Patients with Candida spp. airway colonization were more likely to develop A. baumannii VAP than non-colonized patients (23% vs 15%, P=.01 and 34% vs. 15%, Pbaumannii VAP (29% vs. 21%, P=.153) but with higher in-hospital mortality (53% vs. 39%, P=.037). Candida spp. airway colonization (43%) and A. baumannii VAP (18%) were common in ICU patients who were on mechanical ventilation for at least 48 hours. Candida spp. airway colonization was an independent risk factor for subsequent A. baumannii VAP.

  12. Severe Osteomyelitis and Septic Arthritis due to Serratia marcescens in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Hiba Hadid

    2015-01-01

    Full Text Available Septic arthritis and osteomyelitis due to Serratia marcescens in immunocompetent patients without risk factors are extremely rare. Here, we report a case of septic arthritis and severe adjacent osteomyelitis of the tibia due to Serratia marcescens in a diabetic community-dweller patient. The patient had no contact with healthcare workers or facilities and had no chronic disease except for poorly controlled diabetes. Without predisposing risk factors, this type of infection is extremely rare, even in diabetics.

  13. Technetium bone scanning as an aid in the diagnosis of atypical acute osteomyelitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Letts, R.M.; Afifi, A.; Sutherland, J.B.

    1975-06-01

    Technetium bone scanning is a simple, safe and accurate method for the diagnosis of acute osteomyelitis in children whose presenting clinical findings are atypical of bone infection. Bone scanning was effective in the localization of the exact site of osteomyelitis, thus facilitating needle aspiration as well as subsequent surgical decompression. Technetium bone scanning is a diagnostic technique for determining bone infection in children who are unable to communicate adequately or in those whose signs have been modified by previous inadequate antibacterial therapy.

  14. Salmonella Osteomyelitis in Previously Healthy Children: Report of 4 Cases and Review of the Literature.

    Science.gov (United States)

    Tsagris, Vasileios; Vliora, Christianna; Mihelarakis, Ioannis; Syridou, Garyfallia; Pasparakis, Dimitrios; Lebessi, Evangelia; Tsolia, Maria

    2016-01-01

    Salmonella osteomyelitis in children is an uncommon condition, typically associated with hemoglobinopathies or other underlying disorders. Only few cases have been reported in children without predisposing factors. We describe 4 cases of Salmonella osteomyelitis in otherwise healthy children. Since treatment duration is expected to be prolonged, the practice of direct inoculation of aspirates into blood culture bottles appears to be essential for diagnosis and targeted therapy.

  15. Anaerobic osteomyelitis of femoral head with intraosseous, intra-articular, bursal and muscle pneumatosis

    Energy Technology Data Exchange (ETDEWEB)

    Potocki, Jason [Department of Orthopaedic Surgery, Medical College of Virginia Hospital, Virginia Commonwealth University, PO Box 980257, Richmond, VA 23298-0615 (United States); Kaushik, Shaifali [Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, 401 N 12th Street, 3-407A, PO Box 980615, Richmond, VA 23298-0615 (United States); Mira, Jose L. [Department of Pathology, Medical College of Virginia Hospital, Virginia Commonwealth University, PO Box 980662, Richmond, VA 23298-0662 (United States)

    2003-01-01

    A case is presented of anaerobic osteomyelitis with intraosseous pneumatosis resulting in extension of gas in soft tissue structures and femur in a patient with mitral valve vegetation and bacteremia. The finding of intraosseous pneumatosis and its extension into the hip joint, iliopsoas bursa and subgluteus medius bursa is depicted. Intraosseous pneumatosis is a rare but concerning finding for osteomyelitis in the absence of a penetrating wound, recent surgery, biopsy or fracture. (orig.)

  16. Septic arthritis and osteomyelitis due to the chromoblastomycosis agent Fonsecaea pedrosoi.

    Science.gov (United States)

    De Guzman, Leonidiz; Perlman, David C; Hubbard, Christopher E

    2012-07-01

    Fonsecaea pedrosoi is the most common agent of chromoblastomycosis, a chronic localized fungal infection of the skin and subcutaneous tissues mainly involving the lower extremities. We report a rare case of septic arthritis and osteomyelitis due to the chromoblastomycosis agent F pedrosoi, which was successfully treated with arthrotomy and debridement, followed by a long course of oral antifungal therapy. To our knowledge, this is the second case of F pedrosoi osteomyelitis treated successfully to be ever reported.

  17. Conservative Surgery of Diabetic Forefoot Osteomyelitis: How Can I Operate on This Patient Without Amputation?

    Science.gov (United States)

    Aragón-Sánchez, Javier; Lázaro-Martínez, Jose L; Alvaro-Afonso, Francisco Javier; Molinés-Barroso, Raúl

    2015-06-01

    Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection. Several issues should be taken into account when considering surgery for treating diabetic foot osteomyelitis. It is necessary to have a surgeon available with diabetic foot expertise. Regarding location of diabetic foot osteomyelitis, it is important to consider whether isolated bone or a joint is involved. In cases in which osteomyelitis is associated with a bone deformity, surgery should be able to correct this. The surgeon should always reflect about whether extensive/radical surgery could destabilize the foot. The forefoot is the most frequent location of diabetic foot osteomyelitis and is associated with better prognosis than midfoot and hindfoot osteomyelitis. Many surgical procedures can be performed in patients with diabetes and forefoot ulcers complicated by osteomyelitis while avoiding amputations. Performing conservative surgeries without amputations of any part of the foot is not always feasible in cases in which the infection has destroyed the soft tissue envelope. Attempting conservative surgery in such cases risks infected tissues remaining in the wound bed leading to failure. The election of different surgical options depends on the expertise of the surgeons selected for the multidisciplinary teams. It is the aim of this article to provide a sample of surgical techniques in order to remove the bone infection from the forefoot while avoiding amputations.

  18. Osteomyelitis caused by Pantoea agglomerans in a closed fracture in a child.

    Science.gov (United States)

    Labianca, Luca; Montanaro, Antonello; Turturro, Francesco; Calderaro, Cosma; Ferretti, Andrea

    2013-02-01

    Development of osteomyelitis in a closed fracture is rare. Although it has been reported that trivial trauma may be associated with the subsequent development of acute osteomyelitis, no evidence has been found that fractures are involved in the etiology of osteomyelitis. Only 25 cases (11 in adolescents) of osteomyelitis after closed fracture have been reported in literature. The authors report a case of osteomyelitis in an 8-year-old girl after a forearm fracture involving the diaphysis of the radius and ulna. Radiographic examinations were performed 5, 14, and 30 days after trauma. At last examination, the forearm appeared swollen and red. Blood culture and radiographs confirmed the clinical suspicion of osteomyelitis. The cultures grew Pantoea agglomerans, a saprophytic gram-negative bacterium commonly isolated from plants, flowers, seeds, water, and soil and sensitive to all of the most common antibiotics. After the arm was immobilized, high doses of intravenous antibiotics were administered for 4 weeks, and oral antibiotics were prescribed for an additional 4 weeks. The patient responded well to treatment. Twelve months after the initial injury, the patient regained full elbow and wrist flexion-extension range of motion. Based on their experience and a review of the literature, the authors suggest that bone infection be considered for patients with closed fractures complicated by excessive or prolonged pain and swelling with evident signs of inflammation where no other obvious infection is apparent. Moreover, in children, bacterial infection may cause osteomyelitis more frequently than in adults, but no evidence exists that a closed fracture increases the incidence of osteomyelitis in children with a systemic infection.

  19. Salvage of a Below Knee Amputation Utilizing Rotationplasty Principles in a Patient with Chronic Tibial Osteomyelitis

    OpenAIRE

    Moralle, Matthew R.; Stekas, Nicholas D.; Reilly, Mark C.; Sirkin, Michael S.; Adams, Mark R.

    2016-01-01

    Introduction: Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide th...

  20. Clivus osteomyelitis secondary to Enterococcus faecium infection in a 6-year-old girl.

    Science.gov (United States)

    Rusconi, R; Bergamaschi, S; Cazzavillan, A; Carnelli, V

    2005-09-01

    A 6-year-old girl was diagnosed to suffer from clivus osteomyelitis secondary to Enterococcus faecium infection. On the basis of the magnetic resonance image, the abscess was drained via the posterior wall of the pharyngeal tract immediately. Subsequent antibiotic therapy allowed rapid improvement and long-term healing of the osteomyelitic process without any side effect. Osteomyelitis or abscess of the clivus is very rare in adult patients and extremely rare in children. Some etiopathogenetic hypotheses are discussed in this case.

  1. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    OpenAIRE

    Bulent M. Ertugrul; Lipsky, Benjamin A.; Savk, Oner

    2013-01-01

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the med...

  2. Diabetic foot infections with osteomyelitis: efficacy of combined surgical and medical treatment

    OpenAIRE

    Widatalla, AbuBakr H. H.; Mahadi, Seif ElDin I.; Shawer, Mohamed A.; Mahmoud, Shadad M.; Abdelmageed, A.E.; Ahmed, Mohamed ElMakki

    2012-01-01

    Diabetic foot infections are a high risk for lower extremity amputation in patients with dense peripheral neuropathy and/or peripheral vascular disease. When they present with concomitant osteomyelitis, it poses a great challenge to the surgical and medical teams with continuing debates regarding the treatment strategy. A cohort prospective study conducted between October 2005 and October 2010 included 330 diabetic patients with osteomyelitis mainly involving the forefoot (study group) and 1,...

  3. Ability of bacteriophage in resolving wound infection caused by multidrug-resistant Acinetobacter baumannii in uncontrolled diabetic rats.

    Science.gov (United States)

    Shivaswamy, VinodKumar Chickmangalure; Kalasuramath, Suneeta Basavaraj; Sadanand, Chethan Kumar; Basavaraju, Abhishek Kilagere; Ginnavaram, Varsha; Bille, Sumanth; Ukken, Sanjay Saju; Pushparaj, Usha Nandini

    2015-04-01

    Acinetobacter baumannii, a substantial nosocomial pathogen, has developed resistance to almost all available antimicrobial drugs. Bacteriophage therapy is a possible alternative treatment for multidrug-resistant (MDR) bacterial infections. In this study, we have successfully isolated bacteriophage active against clinical strains of A. baumannii by enrichment from hospital sewage sludge using representatives of those strains. The bacteriophage isolated against A. baumannii formed plaques against beta-lactamases producing strains of A. baumannii. The utility of bacteriophage specific for A. baumannii to resolve wound infection in uncontrolled diabetic rats was evaluated. Five groups of uncontrolled diabetic rats were used. Group I was noninfected (Control), Group II was infected with MDR A. baumannii and challenged with bacteriophage, Group III was infected with MDR A. baumannii, Group IV was infected with MDR A. baumannii and challenged with antibiotic colistin, and Group V consisted of noninfected rats and sprayed with phage (Phage control). A significant decrease in infection, period of epithelization, and wound contraction was observed in the phage-challenged group when compared with antibiotic-treated uncontrolled diabetic rats and the control group. To conclude the study, new insights are provided into the biology of the broad host range of A. baumannii phage, demonstrating that A. baumannii phage has prospects for the treatment of infections caused by the MDR A. baumannii.

  4. Jaw Osteomyelitis as a Complication of Sickle Cell Anaemia in Three Omani Patients; Case reports and literature review

    Directory of Open Access Journals (Sweden)

    Hilal Al-Ismaili

    2017-03-01

    Full Text Available Sickle cell anaemia (SCA is a common haemoglobinopathy among people from the Middle East, the Afro-Caribbean region, the Mediterranean and East India. While osteomyelitis of the long bones is a welldocumented complication of SCA, there are few documented cases of SCA patients presenting with jaw osteomyelitis. We report three SCA patients with chronic jaw osteomyelitis who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, between 2009 and 2013. Two of the patients had osteomyelitis of the mandible and the third had osteomyelitis of the maxilla. In addition, a brief review of the literature is presented focusing on the clinical presentation, diagnosis and management of jaw osteomyelitis among patients with SCA.

  5. Micro-CT analyses of historical bone samples presenting with osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Lamm, C.; Pietschmann, P. [Medical University Vienna (MUV), Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Vienna (Austria); Dockner, M.; Weber, G.W. [University of Vienna, Department of Anthropology, Vienna (Austria); University of Vienna, Core Facility for Micro-Computed Tomography, Vienna (Austria); Pospischek, B.; Winter, E.; Patzak, B. [Museum of Natural History (NHM), Collection of Anatomical Pathology in the Madhouse Tower, Vienna (Austria); Pretterklieber, M. [Medical University of Vienna (MUV), Department of Applied Anatomy, Vienna (Austria)

    2015-10-15

    Osteomyelitis is an inflammation of the bone marrow mainly caused by bacteria such as Staphylococcus aureus. It typically affects long bones, e.g. femora, tibiae and humeri. Recently micro-computed tomography (μCT) techniques offer the opportunity to investigate bone micro-architecture in great detail. Since there is no information on long bone microstructure in osteomyelitis, we studied historic bone samples with osteomyelitis by μCT. We investigated 23 femora of 22 individuals suffering from osteomyelitis provided by the Collection of Anatomical Pathology, Museum of Natural History, Vienna (average age 44 ±19 years); 9 femora from body donors made available by the Department of Applied Anatomy, Medical University of Vienna (age range, 56-102 years) were studied as controls. Bone microstructure was assessed by μCT VISCOM X 8060 II with a minimal resolution of 18 μm. In the osteomyelitic femora, most prominent alterations were seen in the cortical compartment. In 71.4 % of the individuals with osteomyelitis, cortical porosity occurred. 57.1 % of the individuals showed cortical thinning. In 42.9 % trabecularisation of cortical bone was observed. Osteomyelitis is associated with severe alterations of cortical bone structure otherwise typically observed at old age such as cortical porosity and cortical thinning. (orig.)

  6. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report

    Science.gov (United States)

    Yi, Tae-Im; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-01-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

  7. Predictors of Outcomes in Diabetic Foot Osteomyelitis Treated Initially With Conservative (Nonsurgical) Medical Management: A Retrospective Study

    OpenAIRE

    Zeun, P.; Gooday, C.; Nunney, I.; Dhatariya, K

    2016-01-01

    The optimal way to manage diabetic foot osteomyelitis remains uncertain, with debate in the literature as to whether it should be managed conservatively (ie, nonsurgically) or surgically. We aimed to identify clinical variables that influence outcomes of nonsurgical management in diabetic foot osteomyelitis. We conducted a retrospective study of consecutive patients with diabetes presenting to a tertiary center between 2007 and 2011 with foot osteomyelitis initially treated with nonsurgical m...

  8. [Psoas abscess and lumbar spine osteomyelitis: case report].

    Science.gov (United States)

    Silva, Ana M; Schmalbach, Lauwence A

    2016-10-01

    Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.

  9. Elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

    Science.gov (United States)

    Turhan, Egemen; Ege, Ahmet; Keser, Selcuk; Bayar, Ahmet

    2008-10-01

    Elephantiasis nostras verrucosa represents an infrequent clinical entity with cutaneous changes characterized by dermal fibrosis, hyperkeratotic verrucous and papillamotous lesions resulting from chronic non-filarial lymphedema secondary to infections, surgeries, tumor obstruction, radiation, congestive heart failure, and obesity. Although recurrent streptococcal lymphangitis is believed to play a critical role in the origin of elephantiasis nostras verrucosa, the exact pathogenesis of the disorder is not yet clear. Therapeutic efforts should aim to reduce lymph stasis, which will also lead to improvement of the cutaneous changes but unfortunately there is no specific treatment for advanced cases. In this report, we present a patient who was treated by below knee amputation as a result of elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

  10. Skull Base Osteomyelitis in the Emergency Department: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa Burak Sayhan

    2011-01-01

    Full Text Available Skull base osteomyelitis (SBO is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

  11. Septic Arthritis and Osteomyelitis Caused by Pasteurella multocida.

    Science.gov (United States)

    Vranis, Neil; Paryavi, Ebrahim; Christian, Matthew; Joshi, Manjari; Pensy, Raymond A

    2015-07-01

    This report presents a case of progressive septic arthritis and osteomyelitis caused by a rare pathogen, Pasteurella multocida, thought to be provoked by the use of systemic corticosteroids. Despite initial improvement after antibiotics and surgical procedure, the patient returned with new, associated symptoms 1 month later. This concurrent set of circumstances leading to a life-threatening condition has not been reported, to the best of our knowledge. Physicians aware of such a case will be better prepared to diagnose, treat, and educate their patients. Additionally, the diagnostic challenge presented by this case report emphasizes the need for vigilance and thoroughness in obtaining histories from patients presenting with seemingly benign complaints, especially in vulnerable populations, such as infants, pregnant women, and immunocompromised adults.

  12. Severe maxillary osteomyelitis in a Gray Wolf (Canis lupus)

    Science.gov (United States)

    Barber-Meyer, Shannon

    2012-01-01

    Dental injuries to or abnormalities in functionally important teeth and associated bones in predators may significantly reduce the ability to kill and consume prey (Lazar et al. 2009). This impairment is likely exacerbated in coursing predators, such as Gray Wolves, that bite and hold onto fleeing and kicking prey with their teeth. Damage to carnassials (upper fourth premolar, P4, and lower first molar, M1) and associated bones in Gray Wolves may especially inhibit the consumption of prey because these teeth slice meat and crush bone. Here I report maxillary osteomyelitis involving the carnassials in a wild Gray Wolf from northeastern Minnesota of such severity that I hypothesize it ultimately caused the Gray Wolf to starve to death.

  13. Diagnosing osteomyelitis: evaluation and significance of multiple tracer bone imaging

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, W.B.; Graebner, J.E.; Arenson, D.J.

    The use of various radioactive compounds in the diagnosis of osteomyelitis has been the topic of discussion by numerous authors. A great number of bone imaging agents have been experimented with and clinically applied with varying results. It is the intention of this article to detail and compare the use of two such agents: technetium-99m phosphonate, a phosphorus compound radioactively labeled with an isotope of technetium, and gallium citrate 67, a radioactive isotope of gallium. Both of these materials have specific indications and limitations. However, used in the proper setting, either singularly or in conjunction, they give the clinician precise information about pathologic processes. It is the clinician's careful interpretation of both positive and negative test results that enables him to make proper diagnosis and thus institute appropriate therapy.

  14. "Neonatal septic arthritis and osteomyelitis. Evaluation of risk factors "

    Directory of Open Access Journals (Sweden)

    Nili F

    2001-11-01

    Full Text Available Neonatal septic arthritis and osteomyelitis is not prevalent in first month of the life in new borne children. According to anatomic specifications of bones in this period, the manifestation of disease is different from other periods of life and the disability induced, will be serious and permanent. In this investigation, 31 infants with the diagnosis of septic arthritis and osteomyelitis were studied during 10 years. Hyperbilirubinemia (58.1 percent, emergency cesarean (25.8 percent, umbilical vessel catheterization (26.6 percent, permaturity (12.9 percent, perinatal asphyxia (9.7 percent, scalp laceration (6.5 percent, omphalitis & previous bone fracture (6.5 percent were the most common findings among predisposing factors. Previous hospital admission was detected in 19 patients (67.3 percent and multiple bone involvements demonstrated in 12 (38.7 percent. From those who had risk factors, 42.3 percent had multiple bone lesions. Only 5 patients (16.12 percent had no predisposing factors. The mean age for diagnosis and seeking admission were 23 and 30 days respectively and the mean age of diagnosis at surgery was over 72 hours in 15 (48.38 percent cases. All with delaying in requesting admission had destructive changes in their joints. Knee and hip were most involved (77.3 percent. The most common microorganisms found in this study were staphylococcus aureus and klebsiella. Of all, 47 percent were gram negative & 53 percent gram positive microorganisms. Existence of risk factors and previous hospital admission in the majority of cases accompanied by microorganisms such as methiciline resistant S.aureus and klebsiella as a causative agents who were also resistant to empirical antibiotics demonstrated the role of nosocomial infections as an important cause of infection.

  15. The value of SPET/CT in chronic osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Horger, Marius; Pfannenberg, Christina; Dammann, Florian; Claussen, Claus D. [Department of Diagnostic Radiology, Eberhard-Karls Universitaet, Hoppe-Seyler-Str. 3, 72076, Tuebingen (Germany); Eschmann, Susanne Martina; Bares, Roland [Department of Nuclear Medicine, Eberhard-Karls-Universitaet, Tuebingen (Germany); Storek, Dieter [Department of Traumatology and Orthopaedic Surgery, Eberhard-Karls-Universitaet, Tuebingen (Germany); Vonthein, Reinhard [Department of Medical Biometry, Eberhard-Karls-Universitaet, Tuebingen (Germany)

    2003-12-01

    Immunoscintigraphy with technetium-99m labelled anti-granulocyte antibodies (AGA) is an equivalent technique to imaging with in vitro-labelled leucocytes, which is now considered state of the art in the diagnostic work-up of patients with suspected post-traumatic chronic osteomyelitis. In this study, we evaluated the use of a combined single-photon emission tomography/computed tomography (SPET/CT) device to improve detection and anatomical definition of inflammatory bone lesions. Twenty-seven patients with 29 sites of suspected bone infection underwent immunoscintigraphy with 750 MBq {sup 99m}Tc-labelled AGA. Planar scans were acquired immediately, 4 h and 24 h after injection, and combined SPET/CT was performed using a dual-head multifunctional gamma camera equipped with a low-power X-ray system. Accumulation of AGA in inflammatory lesions was quantitated, comparing uptake at 4 and 24 h after injection. The validation was based on culture data derived from surgical or biopsy samples (20 lesions in 18 patients) or clinical follow-up without further therapy for more than 6 months (nine lesions). On a lesion-by-lesion basis 19 true positive, one false positive and nine true negative findings were obtained. SPET/CT correctly identified the location of all positive foci in the appendicular skeleton and that of a cold lesion in the axial skeleton. It also enabled differentiation between soft tissue infection, septic arthritis and osteomyelitis, as well as between cortical, corticomedullary and subperiosteal foci. Sensitivity was identical for SPET and SPET/CT (100%), whereas specificity was improved from 78% to 89% by the use of SPET/CT. Combined SPET/CT improves the accuracy of immunoscintigraphy by allowing correct differentiation between soft tissue infection and bone involvement. This technique may gain clinical relevance in the selection of patients for surgical therapy. (orig.)

  16. Antibiotic modulation of capsular exopolysaccharide and virulence in Acinetobacter baumannii.

    Directory of Open Access Journals (Sweden)

    Edward Geisinger

    2015-02-01

    Full Text Available Acinetobacter baumannii is an opportunistic pathogen of increasing importance due to its propensity for intractable multidrug-resistant infections in hospitals. All clinical isolates examined contain a conserved gene cluster, the K locus, which determines the production of complex polysaccharides, including an exopolysaccharide capsule known to protect against killing by host serum and to increase virulence in animal models of infection. Whether the polysaccharides determined by the K locus contribute to intrinsic defenses against antibiotics is unknown. We demonstrate here that mutants deficient in the exopolysaccharide capsule have lowered intrinsic resistance to peptide antibiotics, while a mutation affecting sugar precursors involved in both capsule and lipopolysaccharide synthesis sensitizes the bacterium to multiple antibiotic classes. We observed that, when grown in the presence of certain antibiotics below their MIC, including the translation inhibitors chloramphenicol and erythromycin, A. baumannii increases production of the K locus exopolysaccharide. Hyperproduction of capsular exopolysaccharide is reversible and non-mutational, and occurs concomitantly with increased resistance to the inducing antibiotic that is independent of the presence of the K locus. Strikingly, antibiotic-enhanced capsular exopolysaccharide production confers increased resistance to killing by host complement and increases virulence in a mouse model of systemic infection. Finally, we show that augmented capsule production upon antibiotic exposure is facilitated by transcriptional increases in K locus gene expression that are dependent on a two-component regulatory system, bfmRS. These studies reveal that the synthesis of capsule, a major pathogenicity determinant, is regulated in response to antibiotic stress. Our data are consistent with a model in which gene expression changes triggered by ineffectual antibiotic treatment cause A. baumannii to transition

  17. Molecular detection of aminoglycoside-modifying enzyme genes in Acinetobacter baumannii clinical isolates.

    Science.gov (United States)

    Heidary, Mohsen; Salimi Chirani, Alireza; Khoshnood, Saeed; Eslami, Gita; Atyabi, Seyyed Mohammad; Nazem, Habibollah; Fazilati, Mohammad; Hashemi, Ali; Soleimani, Saleh

    2016-12-16

    Acinetobacter baumannii is a major opportunistic pathogen in healthcare settings worldwide. In Iran, there are only few reports on the prevalence of aminoglycoside resistance genes among A. baumannii isolates. The aim of this study was to investigate the existence of aminoglycoside-modifying enzyme (AME) genes from A. baumannii strains collected at a university teaching hospital in Iran. One hundred A. baumannii strains were collected between 2014 and 2015 from hospitalized patients at Loghman Hakim Hospital, Tehran, Iran. Antimicrobial susceptibility was determined by disk diffusion method according to the Clinical and Laboratory Standards Institute recommendations. The DNA was extracted using a kit obtained from Bioneer Co. (Korea) and was used as a template for polymerase chain reaction. The most active antimicrobial agent against these strains was colistin. The rate of extended-spectrum cephalosporin resistance was 97%. The aadA1, aadB, aac(6')-Ib, and aac(3)-IIa genes were found in 85%, 77%, 72%, and 68% of A. baumannii isolates, respectively. This study showed a high prevalence rate of AME genes in A. baumannii. This prevalence rate has explained that further aminoglycoside resistance genes may have role in the resistance of clinical isolates of A. baumannii. Therefore, control and treatment of serious infections caused by this opportunistic pathogen should be given more consideration.

  18. Isolation and characterization of antimicrobial compounds in plant extracts against multidrug-resistant Acinetobacter baumannii.

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    Yoko Miyasaki

    Full Text Available The number of fully active antibiotic options that treat nosocomial infections due to multidrug-resistant Acinetobacter baumannii (A. baumannii is extremely limited. Magnolia officinalis, Mahonia bealei, Rabdosia rubescens, Rosa rugosa, Rubus chingii, Scutellaria baicalensis, and Terminalia chebula plant extracts were previously shown to have growth inhibitory activity against a multidrug-resistant clinical strain of A. baumannii. In this study, the compounds responsible for their antimicrobial activity were identified by fractionating each plant extract using high performance liquid chromatography, and determining the antimicrobial activity of each fraction against A. baumannii. The chemical structures of the fractions inhibiting >40% of the bacterial growth were elucidated by liquid chromatography/mass spectrometry analysis and nuclear magnetic resonance spectroscopy. The six most active compounds were identified as: ellagic acid in Rosa rugosa; norwogonin in Scutellaria baicalensis; and chebulagic acid, chebulinic acid, corilagin, and terchebulin in Terminalia chebula. The most potent compound was identified as norwogonin with a minimum inhibitory concentration of 128 µg/mL, and minimum bactericidal concentration of 256 µg/mL against clinically relevant strains of A. baumannii. Combination studies of norwogonin with ten anti-Gram negative bacterial agents demonstrated that norwogonin did not enhance the antimicrobial activity of the synthetic antibiotics chosen for this study. In conclusion, of all identified antimicrobial compounds, norwogonin was the most potent against multidrug-resistant A. baumannii strains. Further studies are warranted to ascertain the prophylactic and therapeutic potential of norwogonin for infections due to multidrug-resistant A. baumannii.

  19. Antimicrobial Resistance of Acinetobacter baumannii to Imipenem in Iran: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Pourhajibagher, Maryam; Hashemi, Farhad B; Pourakbari, Babak; Aziemzadeh, Masoud; Bahador, Abbas

    2016-01-01

    Imipenem-resistant multi-drug resistant (IR-MDR) Acinetobacter baumannii has been emerged as a morbidity successful nosocomial pathogen throughout the world.To address imipenem being yet the most effective antimicrobial agent against A. baumannii to control outbreaks and treat patients, a systematic review and meta-analysis was performed to evaluate the prevalence of IR-MDR A. baumannii. We systematically searched Web of Science, PubMed, MEDLINE, Science Direct, EMBASE, Scopus, Cochrane Library, Google Scholar, and Iranian databases to identify studies addressing the antibiotic resistance of A. baumannii to imipenem and the frequency of MDR strains in Iran. Out of 58 articles and after a secondary screening using inclusion and exclusion criteria and on the basis of title and abstract evaluation, 51 studies were selected for analysis. The meta-analysis revealed that 55% [95% confidence interval (CI), 53.0-56.5] of A. baumannii were resistant to imipenem and 74% (95% CI, 61.3-83.9) were MDR. The MDR A. baumannii population in Iran is rapidly changing toward a growing resistance to imipenem. Our findings highlight the critical need for a comprehensive monitoring and infection control policy as well as a national susceptibility review program that evaluates IR-MDR A. baumannii isolates from various parts of Iran.

  20. Acinetobacter baumannii Coordinates Urea Metabolism with Metal Import To Resist Host-Mediated Metal Limitation

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    Lillian J. Juttukonda

    2016-09-01

    Full Text Available During infection, bacterial pathogens must adapt to a nutrient metal-limited environment that is imposed by the host. The innate immune protein calprotectin inhibits bacterial growth in vitro by chelating the divalent metal ions zinc (Zn2+, Zn and manganese (Mn2+, Mn, but pathogenic bacteria are able to cause disease in the presence of this antimicrobial protein in vivo. One such pathogen is Acinetobacter baumannii, a Gram-negative bacterium that causes pneumonia and bloodstream infections that can be complicated by resistance to multiple antibiotics. A. baumannii inhibition by calprotectin is dependent on calprotectin Mn binding, but the mechanisms employed by A. baumannii to overcome Mn limitation have not been identified. This work demonstrates that A. baumannii coordinates transcription of an NRAMP family Mn transporter and a urea carboxylase to resist the antimicrobial activities of calprotectin. This NRAMP family transporter facilitates Mn accumulation and growth of A. baumannii in the presence of calprotectin. A. baumannii is found to utilize urea as a sole nitrogen source, and urea utilization requires the urea carboxylase encoded in an operon with the NRAMP family transporter. Moreover, urea carboxylase activity is essential for calprotectin resistance in A. baumannii. Finally, evidence is provided that this system combats calprotectin in vivo, as deletion of the transporter impairs A. baumannii fitness in a mouse model of pneumonia, and this fitness defect is modulated by the presence of calprotectin. These findings reveal that A. baumannii has evolved mechanisms to subvert host-mediated metal sequestration and they uncover a connection between metal starvation and metabolic stress.

  1. Role of macrophages in early host resistance to respiratory Acinetobacter baumannii infection.

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    Hongyu Qiu

    Full Text Available Acinetobacter baumannii is an emerging bacterial pathogen that causes nosocomial pneumonia and other infections. Although it is recognized as an increasing threat to immunocompromised patients, the mechanism of host defense against A. baumannii infection remains poorly understood. In this study, we examined the potential role of macrophages in host defense against A. baumannii infection using in vitro macrophage culture and the mouse model of intranasal (i.n. infection. Large numbers of A. baumannii were taken up by alveolar macrophages in vivo as early as 4 h after i.n. inoculation. By 24 h, the infection induced significant recruitment and activation (enhanced expression of CD80, CD86 and MHC-II of macrophages into bronchoalveolar spaces. In vitro cell culture studies showed that A. baumannii were phagocytosed by J774A.1 (J774 macrophage-like cells within 10 minutes of co-incubation, and this uptake was microfilament- and microtubule-dependent. Moreover, the viability of phagocytosed bacteria dropped significantly between 24 and 48 h after co-incubation. Infection of J774 cells by A. baumannii resulted in the production of large amounts of proinflammatory cytokines and chemokines, and moderate amounts of nitric oxide (NO. Prior treatment of J774 cells with NO inhibitors significantly suppressed their bactericidal efficacy (P<0.05. Most importantly, in vivo depletion of alveolar macrophages significantly enhanced the susceptibility of mice to i.n. A. baumannii challenge (P<0.01. These results indicate that macrophages may play an important role in early host defense against A. baumannii infection through the efficient phagocytosis and killing of A. baumannii to limit initial pathogen replication and the secretion of proinflammatory cytokines and chemokines for the rapid recruitment of other innate immune cells such as neutrophils.

  2. Combination therapy in severe Acinetobacter baumannii infections: an update on the evidence to date.

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    Durante-Mangoni, Emanuele; Utili, Riccardo; Zarrilli, Raffaele

    2014-01-01

    Acinetobacter baumannii is a drug-resistant Gram-negative pathogen increasingly causing hospital-acquired infections in critically ill patients. In this review, we summarize the current mechanisms of antimicrobial resistance in A. baumannii and describe in detail recent in vitro and in vivo experimental data on the activity of antimicrobial combinations against this microorganism. We then introduce the rationale for the use of combination antibiotic therapy in resistant A. baumannii infections. Finally, we present and critically discuss both uncontrolled clinical studies and the few randomized clinical trials of combination antimicrobial therapy for these infections, with a special focus on ongoing multinational trials and optimal approach to future research in this field.

  3. CHRONIC OSTEOMYELITIS: A BACTERIOLOGICAL STUDY WITH SPECIAL REFERENCE TO STAPHYLOCOCCUS AUREUS

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    Sanjoy Chakravarty

    2015-01-01

    Full Text Available Advances in the identification of infections and early diagnosis of Osteomyelitis have led to the improved management of Osteomyelitis. This study was undertaken to determine the bacteriological profile of Osteomyelitis and the antibiotic resistance pattern of various isolates obtained as it is an important cause of morbidity. A total of 50 patients of Osteomyelitis either attending the outpatient department or admitted in the wards of a teaching and tertiary care hospita l in Sikkim from October 2013 to October, 2014 were included in the study. All those patients who were clinically and/ or radiologically suspected of having Osteomyelitis were enrolled as cases. Pus/ pus swabs or sequestrum samples taken aseptically were c ultured aerobically at 37 0 C for 18 - 24 hours in Blood and Mac Conkey agar plates. Culture isolates were identified by a series of standard biochemical reactions. Antibiotic susceptibility was tested on Mueller Hinton agar by Kirby Bauer disc diffusion met hod. Betalactamase production of S. aureus strains were verified by iodometric filter paper and acidometric agar plate methods. S. aureus strains were screened for methicillin resistance by using conventional microbiological methods. S. aureus turned out t o be the most common organism isolated. Other organism isolated were P. Aeruginosa, Proteus spp., Klebsiella spp., E. coli, Enterobacter spp., S. epidermitis, Streptococcus pyogens and Enterococcus spp. Beta - lactamase production and methicillin resistance was seen in S. aureus strains respectively. Multidrug resistance was observed in other strains. Infection caused by Methicillin resistant S. aureus and multidrug resistant organisms are posing a major challenge in the treatment of Osteomyelitis. So, appropriate drug selected by antibiotic sensitivity testing should be used to treat Osteomyelitis

  4. Systematic approach to treat chronic osteomyelitis through localized drug delivery system: Bench to bed side

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    Bhattacharya, Rupnarayan [Department of Plastic Surgery, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata 700004 (India); Kundu, Biswanath, E-mail: biswa_kundu@rediffmail.com [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India); Nandi, Samit Kumar, E-mail: samitnandi1967@gmail.com [Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences (WBUAFS), Kolkata 700037 (India); Basu, Debabrata [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India)

    2013-10-15

    Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone–sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8–18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50–55% porosity, average pore size 110 μm, higher interconnectivity (10–100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. - Highlights: • Chronic osteomyelitis is challenging setback to decide optimal therapeutic strategy. • Micro- to macro-porous antibiotic CFS impregnated HAp scaffolds were fabricated. • Complete in vivo animal trial done after developing osteomyelitis in rabbit tibia. • Clinical trial showed fracture union without recurrence of infection after 8 months. • This may be a new, alternative, cost effective and ideal therapeutic strategy.

  5. Genetic Regulation of Virulence and Antibiotic Resistance in Acinetobacter baumannii.

    Science.gov (United States)

    Kröger, Carsten; Kary, Stefani C; Schauer, Kristina; Cameron, Andrew D S

    2016-12-28

    Multidrug resistant microorganisms are forecast to become the single biggest challenge to medical care in the 21st century. Over the last decades, members of the genus Acinetobacter have emerged as bacterial opportunistic pathogens, in particular as challenging nosocomial pathogens because of the rapid evolution of antimicrobial resistances. Although we lack fundamental biological insight into virulence mechanisms, an increasing number of researchers are working to identify virulence factors and to study antibiotic resistance. Here, we review current knowledge regarding the regulation of virulence genes and antibiotic resistance in Acinetobacter baumannii. A survey of the two-component systems AdeRS, BaeSR, GacSA and PmrAB explains how each contributes to antibiotic resistance and virulence gene expression, while BfmRS regulates cell envelope structures important for pathogen persistence. A. baumannii uses the transcription factors Fur and Zur to sense iron or zinc depletion and upregulate genes for metal scavenging as a critical survival tool in an animal host. Quorum sensing, nucleoid-associated proteins, and non-classical transcription factors such as AtfA and small regulatory RNAs are discussed in the context of virulence and antibiotic resistance.

  6. Genetic Regulation of Virulence and Antibiotic Resistance in Acinetobacter baumannii

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    Carsten Kröger

    2016-12-01

    Full Text Available Multidrug resistant microorganisms are forecast to become the single biggest challenge to medical care in the 21st century. Over the last decades, members of the genus Acinetobacter have emerged as bacterial opportunistic pathogens, in particular as challenging nosocomial pathogens because of the rapid evolution of antimicrobial resistances. Although we lack fundamental biological insight into virulence mechanisms, an increasing number of researchers are working to identify virulence factors and to study antibiotic resistance. Here, we review current knowledge regarding the regulation of virulence genes and antibiotic resistance in Acinetobacter baumannii. A survey of the two-component systems AdeRS, BaeSR, GacSA and PmrAB explains how each contributes to antibiotic resistance and virulence gene expression, while BfmRS regulates cell envelope structures important for pathogen persistence. A. baumannii uses the transcription factors Fur and Zur to sense iron or zinc depletion and upregulate genes for metal scavenging as a critical survival tool in an animal host. Quorum sensing, nucleoid-associated proteins, and non-classical transcription factors such as AtfA and small regulatory RNAs are discussed in the context of virulence and antibiotic resistance.

  7. Transcriptome Remodeling of Acinetobacter baumannii during Infection and Treatment

    Science.gov (United States)

    Wright, Meredith S.; Jacobs, Michael R.; Bonomo, Robert A.

    2017-01-01

    ABSTRACT Acinetobacter baumannii is an increasingly common multidrug-resistant pathogen in health care settings. Although the genetic basis of antibiotic resistance mechanisms has been extensively studied, much less is known about how genetic variation contributes to other aspects of successful infections. Genetic changes that occur during host infection and treatment have the potential to remodel gene expression patterns related to resistance and pathogenesis. Longitudinal sets of multidrug-resistant A. baumannii isolates from eight patients were analyzed by RNA sequencing (RNA-seq) to identify differentially expressed genes and link them to genetic changes contributing to transcriptional variation at both within-patient and population levels. The number of differentially expressed genes among isolates from the same patient ranged from 26 (patient 588) to 145 (patient 475). Multiple patients had isolates with differential gene expression patterns related to mutations in the pmrAB and adeRS two-component regulatory system genes, as well as significant differences in genes related to antibiotic resistance, iron acquisition, amino acid metabolism, and surface-associated proteins. Population level analysis revealed 39 genetic regions with clade-specific differentially expressed genes, for which 19, 8, and 3 of these could be explained by insertion sequence mobilization, recombination-driven sequence variation, and intergenic mutations, respectively. Multiple types of mutations that arise during infection can significantly remodel the expression of genes that are known to be important in pathogenesis. PMID:28270585

  8. Genetic Regulation of Virulence and Antibiotic Resistance in Acinetobacter baumannii

    Science.gov (United States)

    Kröger, Carsten; Kary, Stefani C.; Schauer, Kristina; Cameron, Andrew D. S.

    2016-01-01

    Multidrug resistant microorganisms are forecast to become the single biggest challenge to medical care in the 21st century. Over the last decades, members of the genus Acinetobacter have emerged as bacterial opportunistic pathogens, in particular as challenging nosocomial pathogens because of the rapid evolution of antimicrobial resistances. Although we lack fundamental biological insight into virulence mechanisms, an increasing number of researchers are working to identify virulence factors and to study antibiotic resistance. Here, we review current knowledge regarding the regulation of virulence genes and antibiotic resistance in Acinetobacter baumannii. A survey of the two-component systems AdeRS, BaeSR, GacSA and PmrAB explains how each contributes to antibiotic resistance and virulence gene expression, while BfmRS regulates cell envelope structures important for pathogen persistence. A. baumannii uses the transcription factors Fur and Zur to sense iron or zinc depletion and upregulate genes for metal scavenging as a critical survival tool in an animal host. Quorum sensing, nucleoid-associated proteins, and non-classical transcription factors such as AtfA and small regulatory RNAs are discussed in the context of virulence and antibiotic resistance. PMID:28036056

  9. Osteomielitis vertebral piógena Pyogenic vertebral osteomyelitis

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    Pedro P. Perrotti

    2009-10-01

    Full Text Available La osteomielitis vertebral piógena (OVP es una localización poco frecuente (2-7% Se confirma con el aislamiento de un microorganismo de una vértebra, disco intervertebral, absceso epidural o paravertebral. Se describe una serie de casos por la infrecuente presentación de esta enfermedad, que puede ser consulta inicial en los servicios de clínica médica y por su sintomatología inespecífica que supone una dificultad diagnóstica. Tanto la columna lumbar como la dorsal fueron los sitios más afectados. El dolor dorsolumbar y la paraparesia fueron los síntomas más frecuentes de presentación. En ocho pacientes se aislaron Staphylococcus aureus, en uno Escherichia coli y en el restante Haemophylus sp. Se observó leucocitosis sólo en tres pacientes, y en dos velocidad de sedimentación globular mayor de 100 mm/h. Los diez pacientes presentaron imágenes características de osteomielitis vertebral piógena en la resonancia nuclear magnética. Dentro de las complicaciones, los abscesos paravertebrales y epidurales fueron los más frecuentes (en cinco enfermos. Además, un paciente presentó empiema pleural. De los diez pacientes de esta serie, siete recibieron inicialmente tratamiento médico empírico y luego específico para el germen aislado. En los restantes el tratamiento fue guiado de acuerdo al antibiograma. A dos enfermos fue necesario realizarles laminectomía descompresiva por compromiso de partes blandas y a otros dos estabilización quirúrgica por inestabilidad espinal, observándose buena evolución en todos los casos. Esta serie demuestra que, ante un paciente con dolor dorsolumbar y síntomas neurológicos se deberá tener en cuenta esta entidad para evitar un retraso en el tratamiento.Pyogenic osteomyelitis seldom affects the spine (2-7%. It is diagnosed by the isolation of a bacterial agent in the vertebral body, the intervertebral disks or from paravertebral or epidural abscesses. We report a retrospective study of ten

  10. Temporal bone osteomyelitis: the relationship with malignant otitis externa, the diagnostic dilemma, and changing trends.

    Science.gov (United States)

    Chen, Jia-Cheng; Yeh, Chien-Fu; Shiao, An-Suey; Tu, Tzong-Yang

    2014-01-01

    Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

  11. Temporal Bone Osteomyelitis: The Relationship with Malignant Otitis Externa, the Diagnostic Dilemma, and Changing Trends

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    Jia-Cheng Chen

    2014-01-01

    Full Text Available Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

  12. Herpes Zoster Induced Osteomyelitis in the Immunocompromised Patients: A 10-year Multicenter Study

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    Reza Tabrizi

    2014-09-01

    Full Text Available Statement of the Problem: Alveolar bone necrosis induced by Herpes zoster infection is considered as a rare manifestation of osteomyelitis and few case reports are presented in the literature. Purpose: The aim of this study was to evaluate mandibular osteomyelitis caused by herpes zoster in the immunocompromised patients with histopathologically documented osteomyelitis in the mandible and herpes zoster infection. Materials and Method: 30 patients were recruited in this cross-sectional study. 19 patients were completely edentulous, 4 patients were partially edentulous and 7 with complete dentition. In all cases, specimens were analyzed using a conventional polymerase chain reaction (PCR test for varicella zoster virus. Results: 16 patients underwent dialysis, 9 patients received chemotherapy treat-ments and 5 patients had transplantation (four kidneys and one liver. Histopa-thological assessment demonstrated a nonspecific bone necrosis exhibiting an eosinophilic, homogeneous non-vital bone tissue with peripheral resorption sur-rounded by reactive connective tissue. PCR test was positive in 21 cases. Conclusion: This study demonstrated that the frequency of osteomyelitis induced by herpes zoster could be more than the records provided by previous studies. Histopathological findings might be nonspecific in such patients. PCR test was not positive for all HZ induced osteomyelitis patients.

  13. Role of Nasal Endoscopy in Chronic Osteomyelitis of Maxilla and Zygoma: A Case Report

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    J. S. Arunkumar

    2011-01-01

    Full Text Available Osteomyelitis of the jaws was relatively common before the era of antibiotic therapy and preventive and restorative dentistry. Osteomyelitis is an acute or chronic inflammatory process that can involve cortical and trabecular aspects of bone or bone marrow. Cranial bones are infrequently involved, but spreading of inflammation with involvement of surrounding structures represents important risk, such as cerebral abscess, encephalitis, or meningitis. The mandible is more commonly involved than the maxilla. Dentogenic infections cause 38% of mandibular and 25% of maxillary involvement. Involvement of zygoma is very rare. Factors like viral fevers, malnutrition, malaria, anemia,tobacco chewing, immunodeficiency, osteopetrosis, Paget’s disease of bone, and florid cemento-osseous dysplasia (FCOD result in decreased vascularity of the affected bone, predisposing to the development of osteomyelitis. We present a case of osteomyelitis of left maxilla and zygoma with oroantral fistula in an immunocompetent adult male caused by dentogenic infection. The complete resolution of infection was gained with surgical treatment using nasal endoscope and antibiotic therapy. The aims of this paper are to illustrate diagnostic patterns, to report radiographic findings and surgical treatment using nasal endoscope in a case of osteomyelitis of maxilla and zygoma. The prognosis and cosmetic results are discussed.

  14. Prolonged anti-bacterial activity of ion-complexed doxycycline for the treatment of osteomyelitis.

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    Oh, Se Heang; Nam, Bo Ra; Lee, In Soo; Lee, Jin Ho

    2016-01-01

    The main purposes of the present study are the fabrication of an ion-complexed antibiotic which allows for the continuous release of the drug for sufficient periods of time without any additional matrix leading to unfavorable tissue responses, and the feasibility study of the ion-complexed antibiotic as a therapeutic system for osteomyelitis using an animal model. An ion-complexed doxycycline (icDX) as an antibiotic was prepared by simple mixing of positively charged doxycycline hyclate (DX) and negatively charged multivalent Na2HPO4 (2Na(+) HPO4(2-)) aqueous solutions. The icDX showed a controlled release of the DX up to 6 weeks. From the in vivo feasibility study using an osteomyelitis rat model, the icDX group showed a more effective therapeutic effect for the osteomyelitis, at 3 and 6 weeks, compared to the non-treated control and free DX groups. This was due to the sustained release of DX from the icDX in the osteomyelitis bone (medullary cavity) without migration. These findings suggest that the icDX may be a promising local delivery system in the clinical field for the treatment of the osteomyelitis.

  15. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis.

    Science.gov (United States)

    Oh, Eun Jo; Oh, Se Heang; Lee, In Soo; Kwon, Oh Soo; Lee, Jin Ho

    2016-05-01

    Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin (F68-VAcements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement (VAcement). TheF68 (7 wt%)-VAcement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth ofS. aureus(zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that theF68 (7 wt%)-VAcement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis.

  16. Neglected Foreign Body, the Cause of Navicular Osteomyelitis in A Paediatric Foot: A Case Report

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    Chandrashekara C.M

    2013-07-01

    Full Text Available Introduction: Foreign body injuries with date thorns, metal and wooden splinters are common in Middle East region, as most of it is desert. Some of the injuries lead to cellulitis or abscess formation, if neglected or improperly managed results in osteomyelitis or septic arthritis of foot structures. This is the first report of isolated navicular osteomyelitis following neglected foreign body in a paediatric foot. Case Report: A 10 year old male patient presented with discharging sinus in left mid-foot 3 years after penetrating injury with wooden splinter. The diagnosis of navicular osteomelitis is confirmed with plain radio-graphs. The ultrasound of foot was done to localize the foreign bodies. Patient was treated with complete removal of foreign body (wooden splinters, surgical debridement and combination of IV and oral cloxacillin for period of 6 weeks. At 18 months follow up, patient had painless foot with no recurrence or collapse of navicular bone. Conclusion: The neglected foreign body can result in osteomyelitis of small bones of foot in pediatric patient. The ultrasound is more useful tool in localizing foreign bodies; those are not radio-opaque. Early and prompt diagnosis with adequate treatment of established osteomyelitis by complete removal of foreign body, curettage and antibiotics can give good results. Keywords: Osteomyelitis; Navicular bone; Foreign body; Paediatric.

  17. Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy

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    Tamer Ahmed EL-Sobky

    2015-01-01

    Full Text Available Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy.

  18. [Osteomyelitis in cat scratch disease: a case report and literature review].

    Science.gov (United States)

    Dusser, P; Eyssette-Guerreau, S; Koné-Paut, I

    2013-06-01

    Cat scratch disease is the most common zoonosis in humans and its typical expression is a persistent benign regional adenopathy. In some rare cases, mono- or multifocal osteomyelitis is described. In this paper, we report the case of bone lesions in a 13-year-old girl infected with cat scratch disease. We have also undertaken a literature review and analyzed 60 other such cases. The manifestation of a bone lesion associated with cat scratch disease was characterized by a mono- or multifocal infectious osteomyelitis, fever, and a general alteration of the patient's health. The most frequent location of osteomyelitis was in the spine. Magnetic resonance imaging appeared the most sensitive test to highlight the bone lesions. Serological findings help reinforce the diagnosis of cat scratch disease caused by Bartonella henselae infection. Osteomyelitis in cat scratch disease is rare but not exceptional. Therefore, it is essential to think about this hypothesis in case of osteomyelitis associated with a general alteration of the patient's health, especially if the lesions are multifocal and if there is a known history of cat contact.

  19. Association between chronic osteomyelitis and deep-vein thrombosis. Analysis of a nationwide population-based registry.

    Science.gov (United States)

    Lin, T-Y; Chen, Y-G; Huang, W-Y; Lin, C-L; Peng, C-L; Sung, F-C; Kao, C-H

    2014-09-02

    Studies on the association between chronic osteomyelitis and deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) are scarce. The aim of this study was to analyse a nationwide population-based database for association between DVT or PE after a diagnosis of chronic osteomyelitis. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with chronic osteomyelitis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The patients with chronic osteomyelitis and comparison controls were selected by 1:1 matching on a propensity score. The propensity score was calculated by a logistic regression to estimate the probability of the treatment assignment given the baseline variables including age, sex, and Charlson comorbidity index score. We analysed the risks of DVT and PE by using Cox proportional hazards regression models, including sex, age, and comorbidities. In total, 24,335 chronic osteomyelitis patients and 24,335 controls were enrolled in the study. The risk of developing DVT was 2.49-fold in patients with chronic osteomyelitis compared with the comparison cohort, after adjusting for age, sex, and comorbidities. The multiplicative increased risks of DVT were also significant in patients with chronic osteomyelitis with any comorbidity. In conclusion, physicians should consider chronic osteomyelitis in their evaluation of risk factors for DVT.

  20. Host-microbe interactions that shape the pathogenesis of Acinetobacter baumannii infection.

    Science.gov (United States)

    Mortensen, Brittany L; Skaar, Eric P

    2012-09-01

    Acinetobacter baumannii is an opportunistic pathogen that has emerged as a prevalent source of nosocomial infections, most frequently causing ventilator-associated pneumonia. The emergence of pan-drug resistant strains magnifies the problem by reducing viable treatment options and effectively increasing the mortality rate associated with Acinetobacter infections. In light of this rising threat, research on A. baumannii epidemiology, antibiotic resistance, and pathogenesis is accelerating. The recent development of both in vitro and in vivo models has enabled studies probing the host-Acinetobacter interface. Bacterial genetic screens and comparative genomic studies have led to the identification of several A. baumannii virulence factors. Additionally, investigations into host defence mechanisms using animal models or cell culture have provided insight into the innate immune response to infection. This review highlights some of the key attributes of A. baumannii virulence with an emphasis on bacterial interactions with the innate immune system.

  1. Multidrug-resistant Acinetobacter baumannii ventriculitis: successful treatment with intraventricular colistin.

    Science.gov (United States)

    López-Alvarez, B; Martín-Láez, R; Fariñas, M C; Paternina-Vidal, B; García-Palomo, J D; Vázquez-Barquero, A

    2009-11-01

    Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.

  2. Insights into the global molecular epidemiology of carbapenem non-susceptible clones of Acinetobacter baumannii.

    Science.gov (United States)

    Karah, Nabil; Sundsfjord, Arnfinn; Towner, Kevin; Samuelsen, Ørjan

    2012-08-01

    The global emergence of multidrug resistance (MDR) among Gram-negative bacteria has dramatically limited the therapeutic options. During the last two decades, Acinetobacter baumannii has become a pathogen of increased clinical importance due to its remarkable ability to cause outbreaks of infections and to acquire resistance to almost all currently used antibiotics, including the carbapenems. This review considers the literature on A. baumannii and data from multilocus sequence typing studies to explore the global population structure of A. baumannii and detect the occurrence of clonality, with the focus on the presence of specific resistance mechanisms such as the OXA-carbapenemases. The worldwide dissemination of MDR and carbapenem non-susceptible A. baumannii is associated with diverse genetic backgrounds, but predominated by a number of extensively distributed clones, such as CC92(B)/CC2(P) and CC109(B)/CC1(P), which have frequently been supplemented by acquired OXA-type carbapenemase genes.

  3. Biofilm formation in clinical isolates of nosocomial Acinetobacter baumannii and its relationship with multidrug resistance

    Directory of Open Access Journals (Sweden)

    Ebrahim Babapour

    2016-06-01

    Conclusions: Since most of the multidrug resistant strains produce biofilm, it seems necessary to provide continuous monitoring and determination of antibiotic susceptibility of clinical A. baumannii. This would help to select the most appropriate antibiotic for treatment.

  4. Distribution of AdeABC efflux system genes in genotypically diverse strains of clinical Acinetobacter baumannii.

    Science.gov (United States)

    Wieczorek, Piotr; Sacha, Paweł; Czaban, Sławomir; Hauschild, Tomasz; Ojdana, Dominika; Kowalczuk, Oksana; Milewski, Robert; Poniatowski, Bogusław; Nikliński, Jacek; Tryniszewska, Elżbieta

    2013-10-01

    Acinetobacter baumannii has emerged as a highly problematic hospital-associated pathogen. Different mechanisms contribute to the formation of multidrug resistance in A. baumannii, including the AdeABC efflux system. Distribution of the structural and regulatory genes encoding the AdeABC efflux system among genetically diverse clinical A. baumannii strains was achieved by using PCR and pulsed-field gel electrophoresis techniques. The distribution of adeABRS genes is extremely high among our A. baumannii strains, except the adeC gene. We have observed a large proportion of strains presenting multidrug-resistance phenotype for several years. The efflux pump could be an important mechanism in these strains in resistance to antibiotics.

  5. Characterization of blaOXA-143 variants in Acinetobacter baumannii and Acinetobacter pittii.

    Science.gov (United States)

    Zander, Esther; Bonnin, Rémy A; Seifert, Harald; Higgins, Paul G

    2014-05-01

    The acquired carbapenem-hydrolyzing oxacillinase (OXA) OXA-143 has thus far been detected only in Acinetobacter baumannii isolates from Brazil. The aim of this study was to characterize three OXA-143 variants: OXA-231 and OXA-253 from carbapenem-resistant A. baumannii isolates and OXA-255 in a carbapenem-susceptible Acinetobacter pittii isolate originating from Brazil, Honduras, and the United States, respectively. The 5' rapid amplification of cDNA ends (RACE) technique identified the same transcription initiation site for all blaOXA-143-like genes and revealed differences in the putative promoter regions. However, all cloned OXA-143 variants conferred carbapenem resistance on A. baumannii ATCC 17978 and OXA-255 conferred carbapenem resistance on A. pittii SH024, which was correlated with blaOXA-255 gene expression. This is the first description of OXA-143-like outside A. baumannii. Detection of OXA-143-like in the United States and Honduras indicates its dissemination through the American continent.

  6. Screening and deciphering antibiotic resistance in Acinetobacter baumannii: a state of the art.

    Science.gov (United States)

    Bonnin, Rémy A; Nordmann, Patrice; Poirel, Laurent

    2013-06-01

    Acinetobacter baumannii, recognized as a serious threat in healthcare facilities, has the ability to develop resistance to antibiotics quite easily. This resistance is related to either gene acquisition (horizontal gene transfer) or mutations in the genome, leading to gene disruption, over- or down-expression of genes. The clinically relevant antibiotic resistances in A. baumannii include resistance to aminoglycosides, broad-spectrum cephalosporins, carbapenems, tigecycline and colistin, which are the last resort antibiotics. The intrinsic and acquired resistance mechanisms of A. baumannii are presented here, with special focus on β-lactam resistance. The most up-to-date techniques for identification, including phenotypical and molecular tests, and screening of those emerging resistance traits are also highlighted. The implementation of early detection and identification of multidrug-resistant A. baumannii is crucial to control their spread.

  7. Acinetobacter Baumannii in Intensive Care Units: prevention –nursing watch over

    OpenAIRE

    Mpitsiori Z

    2013-01-01

    Introduction: Acinetobacter Baumannii belongs to the large family of Acinetobacter, comes from the Greek word still, and for this reason it is called ‘Akinitovaktiridio’. Purpose: to review the recent literature on the genus Acinetobacter Baumannii in ICU and preventive measures against hospital infections. Methods: review from the Greek and foreign literature using keywords. Results: Acinetobacter ,during the last three decades , is of great interest in the medical community, because of the ...

  8. MULTI DRUG RESISTANT ACINETOBACTER BAUMANNII: A SYSTEMATIC REVIEW FOR MICROBIAL AND CLINICAL STUDY

    OpenAIRE

    Buddha Bahadur Basnet; Til Bahadur Basnet; Bishnu Joshi; Rajan Kumar Dahal; Rajani Malla

    2013-01-01

    Infections due to Mutli Drug Resistant A. baumannii (MDRAB) is now recognized as a major public health problem worldwide. The nosocomial infection due to MDRAB has leaded to increased in morbidity and mortality which has added noticeably to significant challenge to modern antibiotic therapy system. This is due to rapid phenomenon of A. baumannii to acquire antibiotic resistance. Thus, in this review the overview of current knowledge on epidemiology, infections, mechanism of resistance and eff...

  9. Novel Bis-Indole Agents Active Against Multidrug-Resistant Acinetobacter baumannii

    Science.gov (United States)

    Jacobs, Michael R.; Bajaksouzian, Saralee; Good, Caryn E.; Butler, Michelle M.; Williams, John D.; Peet, Norton P.; Bowlin, Terry L.; Endimiani, Andrea; Bonomo, Robert A

    2013-01-01

    The in vitro activity of five novel Microbiotix bis-indole agents (MBXs) against 30 multidrug-resistant (MDR) A. baumannii (including 18 resistant to carbapenems) was evaluated. Overall, MIC90s ranged from 1-8 μg/ml, whereas those for imipenem were > 64 μg/ml. MBX 1196 was the most potent (MIC90 1 μg/ml). MBXs are compounds that are highly effective against MDR A. baumannii. PMID:21146724

  10. Prognostic differences between VAP caused by Acinetobacter baumannii and VAP caused by other microorganisms

    OpenAIRE

    Di Bonito, Marianna; Caiazzo, Simona; Iannazzone, Marta; Miccichè, Viviana; De Marco, Giuseppe; De Robertis, Edoardo; Tufano, Rosalba; Piazza, Ornella

    2012-01-01

    Nosocomial infection, in particular pneumonia, is an important risk factor for hospital mortality and morbidity. Acinetobacter baumannii is a common multi-resistant microorganism responsible of Ventilator Associated Pneumonia (VAP). Currently Colistin is a rescue therapy for this pathogen. The purpose of this study is to compare the outcome of VAP caused by Acinetobacter baumannii and VAP by other microorganisms in critical patients. Comorbidity, prognostic scores, mortality and eradication f...

  11. Analysis of drug resistance in 1,861 strains of Acinetobacter baumannii

    OpenAIRE

    JIN, HAO; Qiu, Fan; JI, HONG JIAN; Lu, Qiang

    2016-01-01

    Acinetobacter baumannii is an emerging human pathogen that causes hospital-acquired infections. The trend in increased antimicrobial resistance limits the choice of effective antimicrobial agents. The present study reports the resistance to Acinetobacter baumannii and analyzes the associations between antibiotic use and resistance rates at a general hospital between 2010 and 2014. A total of 1,861 isolates were obtained from clinical cultures, accounting for 10.33% of all detected bacteria (1...

  12. Usefulness of phenotypic and genotypic methods for metallo-beta-lactamases detection in carbapenem-resistant Acinetobacter baumannii strains

    OpenAIRE

    2013-01-01

    Background Acinetobacter baumannii is an opportunistic microorganism with an increasing role in nosocomial outbreaks. For the last 2 decades, a growing number of carbapenem-resistant A. baumannii strains have been identified, including the metallo-beta-lactamases (MBLs) producers. The study aimed to investigate the genetic relatedness of, and MBLs production among, a collection of A. baumannii isolates from Poland. Material/Methods This study involved 78 clinical isolates of carbapenem-resist...

  13. Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

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    Alexander Armstrong

    2013-01-01

    Full Text Available Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO. Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

  14. Improving diagnostic criteria for Propionibacterium acnes osteomyelitis: a retrospective analysis.

    Science.gov (United States)

    Asseray, Nathalie; Papin, Christophe; Touchais, Sophie; Bemer, Pascale; Lambert, Chantal; Boutoille, David; Tequi, Brigitte; Gouin, François; Raffi, François; Passuti, Norbert; Potel, Gilles

    2010-07-01

    The identification of Propionibacterium acnes in cultures of bone and joint samples is always difficult to interpret because of the ubiquity of this microorganism. The aim of this study was to propose a diagnostic strategy to distinguish infections from contaminations. This was a retrospective analysis of all patient charts of those patients with >or=1 deep samples culture-positive for P. acnes. Every criterion was tested for sensitivity, specificity, and positive likelihood ratio, and then the diagnostic probability of combinations of criteria was calculated. Among 65 patients, 52 (80%) were considered truly infected with P. acnes, a diagnosis based on a multidisciplinary process. The most valuable diagnostic criteria were: >or=2 positive deep samples, peri-operative findings (necrosis, hardware loosening, etc.), and >or=2 surgical procedures. However, no single criterion was sufficient to ascertain the diagnosis. The following combinations of criteria had a diagnostic probability of >90%: >or=2 positive cultures + 1 criterion among: peri-operative findings, local signs of infection, >or=2 previous operations, orthopaedic devices; 1 positive culture + 3 criteria among: peri-operative findings, local signs of infection, >or=2 previous surgical operations, orthopaedic devices, inflammatory syndrome. The diagnosis of P. acnes osteomyelitis was greatly improved by combining different criteria, allowing differentiation between infection and contamination.

  15. Comparison of the Virulence-Associated Phenotypes of Five Species of Acinetobacter baumannii Complex.

    Science.gov (United States)

    Na, In Young; Chung, Eun Seon; Jung, Chang-Yun; Kim, Dae Hun; Shin, Juyoun; Kang, KyeongJin; Kim, Seong-Tae; Ko, Kwan Soo

    2016-01-01

    In this study, we compared the virulence-associated factors of Acinetobacter baumannii complex species. Sixty-three isolates of five A. baumannii complex species, including 19 A. baumannii, 15 A. nosocomialis, 13 A. seifertii, 13 A. pittii, and 3 A. calcoaceticus isolates, were included in this study. For all isolates, biofilm formation, A549 cell adherence, resistance to normal human serum, and motility were evaluated. A. baumannii complex isolates showed diversity in biofilm formation, A549 cell adherence, and serum resistance, and no strong positive relationships among these virulence characteristics. However, A. seifertii showed relatively consistent virulence-associated phenotypes. In addition, A. baumannii clone ST110 exhibited consistently high virulence-associated phenotypes. Motility was observed in seven isolates, and all four A. baumannii ST110 isolates showed twitching motility. Although some inconsistencies in virulence-associated phenotypes were seen, high virulence characteristics were observed in A. seifertii, which has been mainly reported in Korea and shows high rates of colistin resistance.

  16. The contribution of nutrient metal acquisition and metabolism to Acinetobacter baumannii survival within the host.

    Science.gov (United States)

    Mortensen, Brittany L; Skaar, Eric P

    2013-01-01

    Acinetobacter baumannii is a significant contributor to intensive care unit (ICU) mortality causing numerous types of infection in this susceptible ICU population, most notably ventilator-associated pneumonia. The substantial disease burden attributed to A. baumannii and the rapid acquisition of antibiotic resistance make this bacterium a serious health care threat. A. baumannii is equipped to tolerate the hostile host environment through modification of its metabolism and nutritional needs. Among these adaptations is the evolution of mechanisms to acquire nutrient metals that are sequestered by the host as a defense against infection. Although all bacteria require nutrient metals, there is diversity in the particular metal needs among species and within varying tissue types and bacterial lifecycles. A. baumannii is well-equipped with the metal homeostatic systems required for the colonization of a diverse array of tissues. Specifically, iron and zinc homeostasis is important for A. baumannii interactions with biotic surfaces and for growth within vertebrates. This review discusses what is currently known regarding the interaction of A. baumannii with vertebrate cells with a particular emphasis on the contributions of metal homeostasis systems. Overall, published research supports the utility of exploiting these systems as targets for the development of much-needed antimicrobials against this emerging infectious threat.

  17. Carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii in the nosocomial setting in Latin America.

    Science.gov (United States)

    Labarca, Jaime A; Salles, Mauro José Costa; Seas, Carlos; Guzmán-Blanco, Manuel

    2016-01-01

    Increasing prevalence of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains in the nosocomial setting in Latin America represents an emerging challenge to public health, as the range of therapeutic agents active against these pathogens becomes increasingly constrained. We review published reports from 2002 to 2013, compiling data from throughout the region on prevalence, mechanisms of resistance and molecular epidemiology of carbapenem-resistant strains of P. aeruginosa and A. baumannii. We find rates of carbapenem resistance up to 66% for P. aeruginosa and as high as 90% for A. baumannii isolates across the different countries of Latin America, with the resistance rate of A. baumannii isolates greater than 50% in many countries. An outbreak of the SPM-1 carbapenemase is a chief cause of resistance in P. aeruginosa strains in Brazil. Elsewhere in Latin America, members of the VIM family are the most important carbapenemases among P. aeruginosa strains. Carbapenem resistance in A. baumannii in Latin America is predominantly due to the oxacillinases OXA-23, OXA-58 and (in Brazil) OXA-143. Susceptibility of P. aeruginosa and A. baumannii to colistin remains high, however, development of resistance has already been detected in some countries. Better epidemiological data are needed to design effective infection control interventions.

  18. Prevalence and resistance ofAcinetobacter baumannii isolated at Hyatabad Medical Complex, Khyber Pakhtunkhwa, Pakistan

    Institute of Scientific and Technical Information of China (English)

    Said Hassan; Farhad Ali; Ibrar Alam; Rahmat Gul

    2016-01-01

    Objective:To assess the resistance against widely used antibiotics in case ofAcinetobacter baumannii (A. baumannii) infection. Methods:A total of 350 samples of pus, urine, swab and others from different patients were examined and the bacterial growth appeared in 50 samples. Each sample was inoculated on blood, MacConkey and cystine lactose electrolyte deficient agar. The antimicrobial susceptibility profile of the isolates was determined using agar plate method/disk-diffusion method (modified-Kirby Baur disc diffusion method). Results: In current study, a large number of isolates ofA. baumannii obtained from different specimens were resistant to avelox (56%), followed by tygacil (46%), augmentin (46%), cefspan (38%), cefixime (24%) and ampicillin (20%). However, the antibiogram ofA. baumannii also showed that most of the isolates (88%) were highly sensitive to cefalexin. Second maximum sensitivity ofA. baumanniiwas seen to amikacin (84%). The sensitivity of isolates against amikacin was followed by ticarcillin (80%). Meronem was found highly active against the tested isolates (78%). Sensitivity was observed for tienem (76%), sulzone (72%) followed by azactam (68%), cefobid (66%) to cefotaxime (66%) and ciproxin (62%). Conclusions:Results elucidate thatA. baumannii is a severe problem as it has become a highly resistant species in hospitalized patients and resistantA. baumannii infection turned out to have increased all-cause mortality.

  19. Molecular Typing of Acinetobacter Baumannii Clinical Strains in Tehran by Pulsed-Field Gel Electrophoresis

    Directory of Open Access Journals (Sweden)

    Neda Farahani

    2013-03-01

    Full Text Available Background & Objective : Currently, Acinetobacter baumannii is an important nosocomial pathogen insofar as its hospital outbreaks have been described from various geographical areas. Since the discrimination of strains within a species is important for delineating nosocomial outbreaks, this study was conducted with the aim of genotyping the A. baumannii clinical strains in Tehran via the pulsed-field gel electrophoresis (PFGE method, which is the most accurate method used for the typing of bacterial species.   Materials & methods: This study was performed on 70 isolates of acinetobacter baumannii isolated from patients from Baqiyatallah, Rasoole Akram, and Milad hospitals in Tehran. Cultural and biochemical methods were used for the identification of the isolates in species level, and then susceptibility tests were carried out on 50 isolates of A. baumannii using the disk diffusion method. The PFGE method was performed on the isolates by Apa I restriction enzyme. Finally, the results of the PFGE were analyzed. Result: Acinetobacter baumannii strains isolated from hospitals in Tehran showed seven different genetic patterns, two of which were sporadic . Also, genotypic profiles were different in each hospital, and different patterns of genetic resistance to common antibiotics were observed. Conclusion: A lthough diversity was observed among the strains of A. baumannii by the PFGE method in Tehran, no epidemic strains were found among them.  

  20. OmpW is a potential target for eliciting protective immunity against Acinetobacter baumannii infections.

    Science.gov (United States)

    Huang, Weiwei; Wang, Shijie; Yao, Yufeng; Xia, Ye; Yang, Xu; Long, Qiong; Sun, Wenjia; Liu, Cunbao; Li, Yang; Ma, Yanbing

    2015-08-26

    Acinetobacter baumannii (A. baumannii) is an important conditioned pathogen that causes nosocomial and community-associated infections. In this study, we sought to investigate whether outer membrane protein W (OmpW) is a potential target for eliciting protective immunity against A. baumannii infections. Mice immunized with the fusion protein thioredoxin-OmpW generated strong OmpW-specific IgG responses. In a sepsis model, both active and passive immunizations against OmpW effectively protected mice from A. baumannii infections. This protection was demonstrated by a significantly improved survival rate, reduced bacterial burdens within organs, and the suppressed accumulation of inflammatory cytokines and chemokines in sera. Opsonophagocytic assays with murine macrophage RAW264.7 cells indicated that the bactericidal effects of the antisera derived from the immunized mice are mediated synergistically by specific antibodies and complement components. The antisera presented significant opsonophagocytic activities against homologous strains and clonally distinct clinical isolates in vitro. Protein data analysis showed that the sequence of OmpW, which has a molecule length of 183 amino acids, is more than 91% conserved in reported A. baumannii strains. In conclusion, we identified OmpW as a highly immunogenic and conserved protein as a valuable antigen candidate for the development of an effective vaccine or the preparation of antisera to control A. baumannii infections.

  1. Antibacterial activity of Hibiscus sabdariffa L. calyces against hospital isolates of multidrug resistant Acinetobacter baumannii

    Institute of Scientific and Technical Information of China (English)

    Emad Mohamed Abdallah

    2016-01-01

    Objective: To evaluate the antibacterial activity of methanol extract of Hibiscus sab-dariffa (H. sabdariffa) calyces employed in Sudanese folk medicine against five hospital isolates of multidrug resistant Acinetobacter baumannii (MDR A. baumannii). Methods: The antibacterial activity of 80% methanol extract (v/v) of H. sabdariffa calyces was evaluated by agar disc diffusion, minimum inhibitory concentration and minimum bactericidal concentration methods. Antibiotic susceptibility of selected A. baumannii strains was tested. Results: In the present investigation, the methanol extract from the calyces of H. sabdariffa exhibited significant antibacterial properties against the non-MDR A. baumannii as well as the MDR A. baumannii strains with a zone of inhibition ranging from (11.3 ± 0.3) to (13.6 ± 0.3) mm. The relative percentage inhibition of H. sabdariffa extract (10 mg/disc) with respect to gentamicin (10 mg/disc) had potent antibacterial properties and was much more effective than gentamicin. Values of mini-mum inhibitory concentration and minimum bactericidal concentration ranged from 25 to 50 and 50 to 100 mg/mL, respectively, revealing the potential bactericidal properties of the extract. Conclusions: According to the present study, the calyces of H. sabdariffa can be used as a substitute source of the current ineffective synthetic antibiotics used against MDR A. baumannii.

  2. Antibacterial activity of Hibiscus sabdariffa L. calyces against hospital isolates of multidrug resistant Acinetobacter baumannii

    Directory of Open Access Journals (Sweden)

    Emad Mohamed Abdallah

    2016-11-01

    Full Text Available Objective: To evaluate the antibacterial activity of methanol extract of Hibiscus sabdariffa (H. sabdariffa calyces employed in Sudanese folk medicine against five hospital isolates of multidrug resistant Acinetobacter baumannii (MDR A. baumannii. Methods: The antibacterial activity of 80% methanol extract (v/v of H. sabdariffa calyces was evaluated by agar disc diffusion, minimum inhibitory concentration and minimum bactericidal concentration methods. Antibiotic susceptibility of selected A. baumannii strains was tested. Results: In the present investigation, the methanol extract from the calyces of H. sabdariffa exhibited significant antibacterial properties against the non-MDR A. baumannii as well as the MDR A. baumannii strains with a zone of inhibition ranging from (11.3 ± 0.3 to (13.6 ± 0.3 mm. The relative percentage inhibition of H. sabdariffa extract (10 mg/disc with respect to gentamicin (10 mg/disc had potent antibacterial properties and was much more effective than gentamicin. Values of minimum inhibitory concentration and minimum bactericidal concentration ranged from 25 to 50 and 50 to 100 mg/mL, respectively, revealing the potential bactericidal properties of the extract. Conclusions: According to the present study, the calyces of H. sabdariffa can be used as a substitute source of the current ineffective synthetic antibiotics used against MDR A. baumannii.

  3. Aptamer-nanobody based ELASA for specific detection of Acinetobacter baumannii isolates.

    Science.gov (United States)

    Rasoulinejad, Samaneh; Gargari, Seyed Latif Mousavi

    2016-08-10

    Acinetobacter baumannii has turned into an important threat in nosocomial outbreak infections and multidrug resistance leading to high mortality rates in the 21st century. In recent years its mortality has increased by 15% which in part could be due to lack of a rapid and sensitive diagnostic test. In this work we introduced a new detection test for A. baumannii with two highly specific aptamer and nanobody molecules. High binding affinity DNA oligonucleotide aptamers toward A. baumannii were selected through 12 rounds of whole cell System Evolution of Ligands by EXponential enrichment process (SELEX). The SELEX procedures was monitored by flow cytometry. The dissociation constant and binding efficiency of the selected aptamer Aci49 was 7.547±1:353pM and 47.50%, respectively. A sandwich enzyme linked aptamer sorbent assay (ELASA) was designed with the biotinylated Aci49 aptamer and our previously developed nanobody against biofilm associated protein (Bap). The assay system was optimized with A. baumannii (ATCC 19606) and 47 clinical isolates of A. baumannii were tested. The threshold of detection in sandwich ELASA process was10(3) CFU/ml. The sensitivity of test toward the clinical isolates was 95.47%. Our results reveal that the sandwich ELASA is sensitive and specific enough for the rapid detection of A. baumannii from clinical isolates.

  4. The contribution of nutrient metal acquisition and metabolism to Acinetobacter baumannii survival within the host

    Directory of Open Access Journals (Sweden)

    Brittany L Mortensen

    2013-12-01

    Full Text Available Acinetobacter baumannii is a significant contributor to intensive care unit (ICU mortality causing numerous types of infection in this susceptible ICU population, most notably ventilator-associated pneumonia. The substantial disease burden attributed to A. baumannii and the rapid acquisition of antibiotic resistance make this bacterium a serious health care threat. A. baumannii is equipped to tolerate the hostile host environment through modification of its metabolism and nutritional needs. Among these adaptations is the evolution of mechanisms to acquire nutrient metals that are sequestered by the host as a defense against infection. Although all bacteria require nutrient metals, there is diversity in the particular metal needs among species and within varying tissue types and bacterial lifecycles. A. baumannii is well-equipped with the metal homeostatic systems required for the colonization of a diverse array of tissues. Specifically, iron and zinc homeostasis is important for A. baumannii interactions with biotic surfaces and for growth within vertebrates. This review discusses what is currently known regarding the interaction of A. baumannii with vertebrate cells with a particular emphasis on the contributions of metal homeostasis systems. Overall, published research supports the utility of exploiting these systems as targets for the development of much-needed antimicrobials against this emerging infectious threat.

  5. Analysis of drug resistance in 1,861 strains of Acinetobacter baumannii

    Science.gov (United States)

    JIN, HAO; QIU, FAN; JI, HONG JIAN; LU, QIANG

    2016-01-01

    Acinetobacter baumannii is an emerging human pathogen that causes hospital-acquired infections. The trend in increased antimicrobial resistance limits the choice of effective antimicrobial agents. The present study reports the resistance to Acinetobacter baumannii and analyzes the associations between antibiotic use and resistance rates at a general hospital between 2010 and 2014. A total of 1,861 isolates were obtained from clinical cultures, accounting for 10.33% of all detected bacteria (1,861/18,016). The strains were mainly from respiratory samples (1,628 isolates, 87.5%) and the intensive care unit (696 isolates, 37.4%). The resistance rates of Acinetobacter baumannii to the majority of antibiotics were >50%, particularly the resistance rate to cefoperazone/sulbactam increased from 47.37 in 2011 to 89.25% in 2014. However, the rates of imipenem and cilastatin sodium decreased from 81.03 to 69.44% due to the antibiotic policy. There were Pearson significant associations between the use of three antibiotics and resistance in Acinetobacter baumannii to this drug, piperacillin/tazobactam (r=0.976, P<0.01), gentamicin (r=0.870, P<0.01) and cefoxitin (r=0.741, P<0.05). Therefore, a combination of drugs should be adopted to treat Acinetobacter baumannii infections. Microbiology laboratory support and surveillance policies are essential to control the emergence of multidrug-resistance Acinetobacter baumannii. PMID:27073633

  6. Osteomyelitis pubis caused by Kingella kingae in an adult patient: Report of the first case

    Directory of Open Access Journals (Sweden)

    Wilmes Dunja

    2012-10-01

    Full Text Available Abstract Background Kingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism. Case presentation We report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an adult patient of 66 years with a history of end-stage renal disease and breast carcinoma. Diagnosis was based on imaging and the microorganism was isolated from Computed Tomography-guided aspiration of synovial fluid. The infection resolved completely after twelve weeks of treatment with oral amoxicillin. Conclusion This case description highlights the importance in osteoarticular infections of systematic inoculation of synovial liquid in BACTEC vials to optimise the detection of causative organisms, which can necessitate specific treatments.

  7. Pelvic osteomyelitis in a 15-year-old girl: case report.

    Science.gov (United States)

    Tural Kara, Tugce; Ozdemir, Halil; Fitoz, Suat; Ciftci, Ergin; Ince, Erdal

    2016-10-01

    Pelvic osteomyelitis is a rare infection. Ilium, ischium, pubis and acetabulum are commonly affected sites. Pelvic radiography, pelvic magnetic resonance and scintigraphy are useful imaging techniques for diagnosis. However, diagnoses should be confirmed with bone biopsy from the lesion. Sometimes diagnosis is delayed because of deep localization of infection site. Here in, we report a 15-year-old girl with left groin pain who was diagnosed as pelvic osteomyelitis one month after initial symptoms. Patient was successfully treated with antibiotics for 8 weeks. In conclusion, although pelvic osteomyelitis is an unusual infection in childhood, it should be considered as differential diagnoses of pain in groin, hips, thigh, abdomen and spine. If diagnosis is suspicious, empiric treatment should be started quickly, because it will be possible to achieve satisfactory clinical results with effective treatment.

  8. Pathological fracture of the right distal radius caused by Enterobacter aerogenes osteomyelitis in an adult.

    Science.gov (United States)

    Lin, Te-Yu; Chi, Hung-Wei; Wang, Ning-Chi

    2010-05-01

    A pathological fracture is a break in a diseased bone caused by weakening of the bone structure by a pathological process with no identifiable trauma. Acute bacterial osteomyelitis that results in pathological fractures in the extremities is rare in adults. To our knowledge, we report the first case of Enterobacter aerogenes osteomyelitis of the right distal radius, complicated with a pathological fracture, in a 79-year-old man with diabetes, which was diagnosed by radiological, microbiological, and histopathological examinations. He recovered well after an 8-week course of antibiotics and surgical debridement. This highlights the fact that radial osteomyelitis should be included in the differential diagnosis when an elderly diabetic patient with no history of trauma presents with pain in the forearm.

  9. Osteomyelitis and infarction in sickle cell hemoglobinopathies: differentiation by combined technetium and gallium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Amundsen, T.R.; Siegel, M.J.; Siegel, B.A.

    1984-12-01

    Clinical records and scintigrams were reviewed of 18 patients with sickle cell hemoglobinophaties who had undergone combined technetium and gallium scintigraphy during 22 separate episodes of suspected osseous infection. The combined scintigrams were correctly interpreted as indicating osteomyelitis in four studies. Of 18 studies in patients with infarction, the combined scintigrams were correctly interpreted in 16 and showed either no local accumulation of Ga-67 or less accumulation than that of Tc-99m MDP at symptomatic sites. In the other two studies, the scintigrams were falsely interpreted as indicating osteomyelitis and showed congruent, increased accumulation of both Tc-99, MDP and Ga-67. This pattern must be considered indeterminate. Overall, the results indicate that the combination of technetium and gallium scintigraphy is an effective means to distinguish osteomyelitis from infarction in patients with sickle cell hemoglobinopathies.

  10. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Luca Castellazzi

    2016-06-01

    Full Text Available Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  11. Orbital necrotizing fasciitis and osteomyelitis caused by arcanobacterium haemolyticum: a case report.

    Science.gov (United States)

    Stone, Lindsay A; Harshbarger, Raymond J

    2015-01-01

    The facial region is infrequently affected by necrotizing infections. Orbital necrotizing infections are even rarer, seen following trauma, local skin infection, and sinusitis. The authors report a unique case of orbital necrotizing fasciitis and osteomyelitis resulting from Arcanobacterium Haemolyticum ethmoid sinusitis. No prior occurrences of Arcanobacterial species orbital necrotizing fasciitis/osteomyelitis have been reported.A 16-year-old boy presented to the ER with a 3-day history of fever, chills, headache, and sinus pressure. CT scan revealed soft tissue swelling of the right orbit, forehead, and ethmoid sinusitis. Within 24 hours of admission, he suffered rapidly progressive swelling and erythema of the right orbit and forehead with diminished visual acuity, despite broad-spectrum antibiotics. Orbital exploration revealed frankly necrotic fascia and periosteum along the superior aspect. Lateral canthotomy, cantholysis, decompression of the optic nerve, and soft tissue debridement with bone biopsy was performed. Operative specimens isolated Arcanobacterium Haemolyticum. Pathologic examination revealed right orbital osteomyelitis.

  12. Alterations of blood serum parameters in patients with chronic hematogenous osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    Sadrudin Magomedov; Larisa Polishchuk

    2015-01-01

    Objective:To examine metabolic disorders of major components of organic basis of bone tissue in patients with chronic hematogenous osteomyelitis and response to surgical treatment. Methods: The cubital vein puncture was conducted to take blood for analysis in patients with chronic hematogenous osteomyelitis. The activity of collagenase and hyaluronidase, elastin, elastase and total content of glycosaminoglycans were measured in blood serum. Results: The study revealed an enhancement of catabolic phase of metabolism of the main components in bone organic matrix during the relapse of inflammation. It was evidenced by indicators reflecting the synthetic and catabolic phases of the main components of the connective tissue collagen and glycosaminoglycans. The effective therapeutic treatments led to the reduction and normalization of studied compounds. Conclusions: The initial development of hematogenous osteomyelitis happens in a background of metabolic disorders of the main components of organic matrix of bone tissue, and normalizes upon effective therapy.

  13. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Ferguson, Polly J; Sandu, Monica

    2012-04-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder that primarily affects children. Its hallmark is recurring episodes of sterile osteomyelitis. The clinical presentation is insidious onset of bone pain with or without fever. Laboratory studies typically reveal nonspecific evidence of inflammation. Radiologic imaging and histologic appearance resemble those of infectious osteomyelitis. There is a strong association with inflammatory disorders of the skin and intestinal tract in affected individuals and their close relatives, suggesting a shared pathophysiology and supporting a genetic component to disease susceptibility. Two genetic syndromes have CRMO as a prominent phenotype-Majeed syndrome and deficiency of the interleukin-1 receptor antagonist-and suggest that interleukin-1 may be a key cytokine in disease pathogenesis. This review briefly summarizes the main clinical and radiologic aspects of the disease and then focuses on genetics and pathophysiology and provides an update on treatment.

  14. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis.

    Science.gov (United States)

    Castellazzi, Luca; Mantero, Marco; Esposito, Susanna

    2016-01-01

    Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  15. Pathology and biofilm formation in a porcine model of staphylococcal osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, L K; Koch, J; Frees, D;

    2012-01-01

    A porcine model was used to examine the potential of human and porcine Staphylococcus aureus isolates to induce haematogenously spread osteomyelitis. Pigs were inoculated in the right femoral artery with one of the following S. aureus strains: S54F9 (from a porcine lung abscess; n = 3 animals......), NCTC-8325-4 (a laboratory strain of human origin; n = 3 animals) and UAMS-1 (a human osteomyelitis isolate; n = 3 animals). Two pigs were sham inoculated with saline. At 11 or 15 days post infection the animals were scanned by computed tomography before being killed and subjected to necropsy...... examination. Osteomyelitis lesions were present in the right hind limb of all pigs inoculated with strain S54F9 and in one pig inoculated with strain NCTC-8325-4. Microscopically, there was extensive loss of bone tissue with surrounding granulation tissue. Sequestrated bone trabeculae were intermingled...

  16. Blood perfusion in osteomyelitis studied with [(15)O]water PET in a juvenile porcine model

    DEFF Research Database (Denmark)

    Jødal, Lars; Nielsen, Ole L; Afzelius, Pia;

    2017-01-01

    BACKGROUND: Osteomyelitis is a serious disease which can be difficult to treat despite properly instituted antibiotic therapy. This appears to be related at least partly to degraded vascularisation in the osteomyelitic (OM) lesions. Studies of perfusion in OM bones are, however, few and not quant......BACKGROUND: Osteomyelitis is a serious disease which can be difficult to treat despite properly instituted antibiotic therapy. This appears to be related at least partly to degraded vascularisation in the osteomyelitic (OM) lesions. Studies of perfusion in OM bones are, however, few...... that perfusion will be less elevated in OM lesions than in soft tissue (ST) infection. The study comprised 11 juvenile pigs with haematogenous osteomyelitis induced by injection of Staphylococcus aureus into the right femoral artery 1 week before scanning (in one pig, 2 weeks). The pigs were dynamically PET...

  17. Differences in Acinetobacter baumannii strains and host innate immune response determine morbidity and mortality in experimental pneumonia.

    Directory of Open Access Journals (Sweden)

    Anna de Breij

    Full Text Available Despite many reports documenting its epidemicity, little is known on the interaction of Acinetobacter baumannii with its host. To deepen our insight into this relationship, we studied persistence of and host response to different A. baumannii strains including representatives of the European (EU clones I-III in a mouse pneumonia model. Neutropenic mice were inoculated intratracheally with five A. baumannii strains and an A. junii strain and at several days morbidity, mortality, bacterial counts, airway inflammation, and chemo- and cytokine production in lungs and blood were determined. A. baumannii RUH875 and RUH134 (EU clone I and II, respectively and sporadic strain LUH8326 resulted in high morbidity/mortality, whereas A. baumannii LUH5875 (EU clone III, which is less widespread than clone I and II caused less symptoms. A. baumannii type strain RUH3023(T and A. junii LUH5851 did not cause disease. All strains, except A. baumannii RUH3023(T and A. junii LUH5851, survived and multiplied in the lungs for several days. Morbidity and mortality were associated with the severity of lung pathology and a specific immune response characterized by low levels of anti-inflammatory (IL-10 and specific pro-inflammatory (IL-12p40 and IL-23 cytokines at the first day of infection. Altogether, a striking difference in behaviour among the A. baumannii strains was observed with the clone I and II strains being most virulent, whereas the A. baumannii type strain, which is frequently used in virulence studies appeared harmless.

  18. The propeller flap for chronic osteomyelitis of the lower extremities: a case report.

    Science.gov (United States)

    Rubino, C; Figus, A; Mazzocchi, M; Dessy, L A; Martano, A

    2009-10-01

    The goals of the treatment of chronic osteomyelitis are infection eradication with systemic antibiotic therapy and local management with radical excision of the infected tissue and obliteration of the remaining dead space. Adequate debridement and coverage with a well-vascularised tissue are mandatory for successful outcomes. Use of muscle covering for chronic osteomyelitis in the lower extremities is considered the best procedure. However, there have been instances where debridement of the bone tissue did not leave a deep cavity along the leg bones and fasciocutaneous flaps can be used in these instances to cover the defect and to restore function without recurrence of the disease. Recently, free non-muscle flaps have been used and assessed for chronic osteomyelitis or covering of exposed bone. Perforator flaps have been shown to be well vascularised due to a structural haemodynamic enhancement. In the light of these findings we report a successful case of chronic osteomyelitis of the right fibula treated with excision of the affected tissue and covering with a propeller flap. Instead of free flap covering, in order to optimise surgical reconstruction, reducing the operative time, donor and recipient site morbidity and risk of total flap failure, local perforator flaps and particularly the propeller flap may be indicated in the treatment of chronic osteomyelitis in selected patients when the defect is limited and there is no need to fill a deep bone cavity or a dead space. To our knowledge, this the first report of the use of a propeller flap in the treatment of chronic osteomyelitis in the lower extremities.

  19. FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Kagna, Olga; Keidar, Zohar [Rambam Health Care Campus, Department of Nuclear Medicine, POB 9602, Haifa (Israel); Srour, Saher; Militianu, Daniela [Rambam Health Care Campus, Department of Diagnostic Imaging, Haifa (Israel); Melamed, Eyal [Rambam Health Care Campus, Department of Orthopedics, Haifa (Israel)

    2012-10-15

    Osteomyelitis, the most serious complication of the diabetic foot, occurs in about 20 % of patients. Early diagnosis is crucial. Appropriate treatment will avoid or decrease the likelihood of amputation. The objective of this study was to assess the value of FDG PET/CT in diabetic patients with clinically suspected osteomyelitis. Enrolled in this prospective study were 39 consecutive diabetic patients (29 men and 10 women, mean age 57 years, range 28-71 years) with 46 suspected sites of foot infection. Of these 39 patients, 38 had type 2 and 1 type 1 diabetes for 4-25 years, and 28 were receiving treatment with insulin. FDG PET/CT was interpreted for the presence, intensity (SUVmax) and localization of increased FDG foci. Final diagnosis was based on histopathology and bacteriology of surgical samples, or clinical and imaging follow-up. Osteomyelitis was correctly diagnosed in 18 and excluded in 21 sites. Of 20 lesions with focal bone FDG uptake, 2 were false-positive with no further evidence of osteomyelitis. Five sites of diffuse FDG uptake involving more than one bone on CT were correctly diagnosed as diabetic osteoarthropathy. FDG PET/CT had a sensitivity, specificity and accuracy of 100 %, 92 % and 95 % in a patient-based analysis and 100 %, 93 % and 96 % in a lesion-based analysis, respectively, for the diagnosis of osteomyelitis in the diabetic foot. FDG PET/CT was found to have high performance indices for evaluation of the diabetic foot. The PET component identified FDG-avid foci in sites of acute infection which were precisely localized on fused PET/CT images allowing correct differentiation between osteomyelitis and soft-tissue infection. (orig.)

  20. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    Science.gov (United States)

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

  1. Co-Culture of S. epidermidis and Human Osteoblasts on Implant Surfaces: An Advanced In Vitro Model for Implant-Associated Infections.

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    Sarah Zaatreh

    Full Text Available Total joint arthroplasty is one of the most frequent and effective surgeries today. However, despite improved surgical techniques, a significant number of implant-associated infections still occur. Suitable in vitro models are needed to test potential approaches to prevent infection. In the present study, we aimed to establish an in vitro co-culture setup of human primary osteoblasts and S. epidermidis to model the onset of implant-associated infections, and to analyze antimicrobial implant surfaces and coatings.For initial surface adhesion, human primary osteoblasts (hOB were grown for 24 hours on test sample discs made of polystyrene, titanium alloy Ti6Al4V, bone cement PALACOS R®, and PALACOS R® loaded with antibiotics. Co-cultures were performed as a single-species infection on the osteoblasts with S. epidermidis (multiplicity of infection of 0.04, and were incubated for 2 and 7 days under aerobic conditions. Planktonic S. epidermidis was quantified by centrifugation and determination of colony-forming units (CFU. The quantification of biofilm-bound S. epidermidis on the test samples was performed by sonication and CFU counting. Quantification of adherent and vital primary osteoblasts on the test samples was performed by trypan-blue staining and counting. Scanning electron microscopy was used for evaluation of topography and composition of the species on the sample surfaces.After 2 days, we observed approximately 104 CFU/ml biofilm-bound S. epidermidis (103 CFU/ml initial population on the antibiotics-loaded bone cement samples in the presence of hOB, while no bacteria were detected without hOB. No biofilm-bound bacteria were detectable after 7 days in either case. Similar levels of planktonic bacteria were observed on day 2 with and without hOB. After 7 days, about 105 CFU/ml planktonic bacteria were present, but only in the absence of hOB. Further, no bacteria were observed within the biofilm, while the number of hOB was decreased to 10

  2. Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case.

    Science.gov (United States)

    Phadke, P S; Gandhi, A R; More, S A; Joshirao, R P

    2017-01-01

    A-21-year old male admitted with fever and piriformis syndrome, typically associated with gluteal region pain radiating down the thigh, was evaluated and found to have pyomyositis involving piriformis and osteomyelitis with sacroiliac joint affection on radiological imaging. Salmonella serotype typhi was isolated from blood culture. He was treated with intravenous Ceftriaxone for 6 weeks with signs of recovery documented clinically as well as on imaging studies. Salmonella pyomyositis with osteomyelitis in an immunocompetent patient with no previous hematological or endocrine disorder makes this case an unusual presentation.

  3. Bug on the back: vertebral osteomyelitis secondary to fluoroquinolone resistant Salmonella typhi in an immunocompetent patient.

    Science.gov (United States)

    Shrestha, Pragya; Mohan, Sachin; Roy, Satyajeet

    2015-11-27

    Although Salmonella osteomyelitis is commonly seen in immunocompromised patients, it may occasionally affect an immunocompetent host. Symptoms are usually non-specific, such as fever, abdominal or back pain; hence it should be considered in the differential diagnosis of patients with a history of travel to endemic regions. Fluoroquinolone resistance is rising and non-responsive patients should be treated with ampicillin, trimethoprim-sulfamethoxazole and ceftriaxone. We present a case of acute T8-T11 osteomyelitis with cord compression caused by a fluoroquinolone resistant strain of Salmonella typhi.

  4. [Mandibular osteomyelitis in a patient with ankylosing spondylitis with severe axial and peripheral involvement].

    Science.gov (United States)

    Tomotani, Daniere Yurie Vieira; Miranda, Aryádine Allinne Machado de; Almeida, Lorena Penha; Mubarac, Rebecca Souza; Neves, Anne Christine Garcia; Ribeiro, Sandra Lúcia Euzébio

    2012-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects mainly the axial skeletal system, causing pain and functional incapacity. The peripheral joint involvement occurs in 30 to 40% of cases. Osteomyelitis of the mandible was relatively common before the advent of preventive antibiotic therapy and restorative dentistry. Currently, the infection of the facial bones is a rare condition, being the odontogenic infection the most responsible for cases with mandibular involvement. The authors report the case of a EA patient, with severe peripheral involvement, which progressed to osteomyelitis of the jaw, secondary to the odontogenic infection due to delay in diagnosis and treatment.

  5. Right ventricular wall abscess in structurally normal heart after leg osteomyelitis: First case.

    Science.gov (United States)

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-09-01

    A 3-year-old girl presented with fever and acute dyspnea for 4 days. She had suffered an injury to the left lower leg 3 weeks earlier, with abscess formation. Magnetic resonance imaging showed osteomyelitis of the lower tibia. Echocardiography showed a mass in the right ventricular wall. She underwent concomitant heart surgery for removal of the right ventricular mass and limb arthrotomy. We believe this is a first reported case in which a ventricular wall abscess developed in a structurally normal heart following leg osteomyelitis.

  6. Skull-base Osteomyelitis: a Dreaded Complication after Trivial Fall and Inadequate Management

    Directory of Open Access Journals (Sweden)

    Kundan Mittal

    2015-10-01

    Full Text Available Introduction: Skull-based osteomyelitis is bony infection which generally originates from inadequately treated chronic infection, adjoining tissue infection or after trauma.Case: 11 month female child had a trivial fall while standing near a bucket. The child developed fracture of right clavicle and left orbital swelling which was inadequately treated. This resulted in in spread of infection to adjoining tissues, skull bones, sinuses and brain.Conclusion: Cranial base osteomyelitis is rare but dreaded condition which requires early diagnosis and prompt treatment to avoid mortality and morbidity in form of neurological deficits and permanent disability

  7. Study on the hard tissue changes in osteomyelitis of the jaws using CT image

    Energy Technology Data Exchange (ETDEWEB)

    An, Chang Hyeon; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul [School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2009-09-15

    To assess the clinical findings and hard tissue changes of osteomyelitis of the jaws using computed tomographic (CT) image analysis. We reviewed and interpreted the CT images of 163 patients (64 males and 99 females, age range from 10 to 87 years) who visited the Seoul National University Dental Hospital from April 23, 2006 to December 31, 2008 and were diagnosed as osteomyelitis of the jaws through clinical, radiologic, and histopathologic examination. Each CT findings was investigated for frequency, correlation with age and gender. Of the 163 patients, 31 (19.0%) were affected on the maxilla, 135 (82.8%) were affected on the mandible, and 3 (1.8%) were affected on the both jaws simultaneously. The mean age of the patients who were affected on the maxilla was 61.0 years and that of the patients who were affected on the mandible was 56.2 years. On the maxilla, the most frequent site of disease was the posterior area (83.9%) and on the mandible, mandibular body (83.0%), followed by angle (48.1%), ramus (38.5%), condyle (13.3%), incisal area (9.6%), and coronoid process (3.0%). Among the 31 maxillary osteomyelitis, defect in the trabecular bone was observed in 28 (90.3%), osteosclerosis 20 (64.5%), defect in the cortical bone 27 (87.1%), sequestrum 17 (54.8%), and periosteal reaction 2 (6.5%). Among the 135 mandibular osteomyelitis, defect in the trabecular bone was observed in 100 (74.1%), osteosclerosis 104 (77.0%), defect in the cortical bone 116 (85.9%), sequestrum 36 (26.7%), and periosteal reaction 67 (49.6%). Of our cases, the maxillary osteomyelitis was visibly observed more frequently in females than males. The incidence is the highest in seventies (28.8%) and the lowest in teens (3.1%). The osteomyelitis of the jaws was observed more frequently in males than females before the age of 50, and observed more frequently in females after the age of 50. The most noticeable point was that the sequestrum was observed more often on maxillary osteomyelitis and the

  8. Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case

    Directory of Open Access Journals (Sweden)

    P S Phadke

    2017-01-01

    Full Text Available A-21-year old male admitted with fever and piriformis syndrome, typically associated with gluteal region pain radiating down the thigh, was evaluated and found to have pyomyositis involving piriformis and osteomyelitis with sacroiliac joint affection on radiological imaging. Salmonella serotype typhi was isolated from blood culture. He was treated with intravenous Ceftriaxone for 6 weeks with signs of recovery documented clinically as well as on imaging studies. Salmonella pyomyositis with osteomyelitis in an immunocompetent patient with no previous hematological or endocrine disorder makes this case an unusual presentation.

  9. A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

    Directory of Open Access Journals (Sweden)

    Brijesh Patel

    2014-01-01

    Full Text Available Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

  10. Optimum treatment strategies for carbapenem-resistant Acinetobacter baumannii bacteremia.

    Science.gov (United States)

    Garnacho-Montero, José; Amaya-Villar, Rosario; Ferrándiz-Millón, Carmen; Díaz-Martín, Ana; López-Sánchez, José María; Gutiérrez-Pizarraya, Antonio

    2015-06-01

    Carbapenem-resistant Acinetobacter baumannii (CRAB) constitutes an increasing problem worldwide. CRAB bacteremia is associated with a high fatality rate and its optimal treatment has not been established. Early institution of appropriate therapy is shown to improve survival of patients with CRAB bloodstream infection. Regrettably, treatment options are limited. Little information exists about the efficacy of sulbactam for the treatment of CRAB bacteremia. Colistin and tigecycline possess good in vitro activity and represent in many cases the only therapeutic options although clinical data are scarce. The need for a loading dose of colistin has been recently demonstrated to rapidly achieve therapeutic levels. The use of combination therapy is also a matter of debate but current evidence do not support its routine use.

  11. Community-acquired Acinetobacter baumannii: clinical characteristics, epidemiology and pathogenesis.

    Science.gov (United States)

    Dexter, Carina; Murray, Gerald L; Paulsen, Ian T; Peleg, Anton Y

    2015-05-01

    Community-acquired Acinetobacter baumannii (CA-Ab) is a rare but serious cause of community-acquired pneumonia in tropical regions of the world. CA-Ab infections predominantly affect individuals with risk factors, which include excess alcohol consumption, diabetes mellitus, smoking and chronic lung disease. CA-Ab pneumonia presents as a surprisingly fulminant course and is characterized by a rapid onset of fever, severe respiratory symptoms and multi-organ dysfunction, with a mortality rate reported as high as 64%. It is unclear whether the distinct clinical syndrome caused by CA-Ab is because of host predisposing factors or unique bacterial characteristics, or a combination of both. Deepening our understanding of the drivers of overwhelming CA-Ab infection will provide important insights into preventative and therapeutic strategies.

  12. Iron acquisition functions expressed by the human pathogen Acinetobacter baumannii.

    Science.gov (United States)

    Zimbler, Daniel L; Penwell, William F; Gaddy, Jennifer A; Menke, Sharon M; Tomaras, Andrew P; Connerly, Pamela L; Actis, Luis A

    2009-02-01

    Acinetobacter baumannii is a gram-negative bacterium that causes serious infections in compromised patients. More recently, it has emerged as the causative agent of severe infections in military personnel wounded in Iraq and Afghanistan. This pathogen grows under a wide range of conditions including iron-limiting conditions imposed by natural and synthetic iron chelators. Initial studies using the type strain 19606 showed that the iron proficiency of this pathogen depends on the expression of the acinetobactin-mediated iron acquisition system. More recently, we have observed that hemin but not human hemoglobin serves as an iron source when 19606 isogenic derivatives affected in acinetobactin transport and biosynthesis were cultured under iron-limiting conditions. This finding is in agreement with the observation that the genome of the strain 17978 has a gene cluster coding for putative hemin-acquisition functions, which include genes coding for putative hemin utilization functions and a TonBExbBD energy transducing system. This system restored enterobactin biosynthesis in an E. coli ExbBD deficient strain but not when introduced into a TonB mutant. PCR and Southern blot analyses showed that this hemin-utilization gene cluster is also present in the 19606 strain. Analysis of the 17978 genome also showed that this strain harbors genes required for acinetobactin synthesis and transport as well as a gene cluster that could code for additional iron acquisition functions. This hypothesis is in agreement with the fact that the inactivation of the basD acinetobactin biosynthetic gene did not affect the growth of A. baumannii 17978 cells under iron-chelated conditions. Interestingly, this second iron uptake gene cluster is flanked by perfect inverted repeats and includes transposase genes that are expressed transcriptionally. Also interesting is the observation that this additional cluster could not be detected in the type strain 19606, an observation that suggests some

  13. Diversity of polymyxin resistance mechanisms among Acinetobacter baumannii clinical isolates.

    Science.gov (United States)

    Girardello, Raquel; Visconde, Marina; Cayô, Rodrigo; Figueiredo, Regina Célia Bressan Queiroz de; Mori, Marcelo Alves da Silva; Lincopan, Nilton; Gales, Ana Cristina

    2017-01-01

    Polymyxins have become drugs of last resort for treatment of multi-drug resistant (MDR) Gram-negative infections. However, the mechanisms of resistance to this compound have not been completely elucidated. In this study, we evaluated the mechanisms of resistance to this antimicrobial in two A. baumannii clinical isolates, respectively, susceptible (A027) and resistant (A009) to polymyxin B before and after polymyxin B exposure (A027(ind) and A009(ind)). The pmrAB and lpxACD were sequenced and their transcriptional levels were analyzed by qRT-PCR. The bacterial cell morphology was evaluated by transmission electronic microscopy (TEM) and the membrane potential was measured using Zeta-potential analyzer. The virulence of strains was studied using a Caenorhabditis elegans model. Both clinical isolates exhibited an elevation of the polymyxin B MIC after exposure to this compound. On the other hand, A027(ind) showed decreased values of MIC for β-lactams, aminoglycosides, vancomycin, teicoplanin, oxacillin and erythromycin. A027(ind) harbored two mutations in pmrB and the ISAba125 disrupting the lpxA. In contrast, A009(ind) strain exhibited increase of pmrB transcriptional level, after polymyxin B exposure, despite the absence of mutations in the pmrAB genes. The TEM images revealed a thicker and more electron-dense peptidoglycan layer for A009 than that of A027. The exposure to polymyxin B induced a strong condensation and darkening of intracellular material, mainly in A009(ind). In addition, the surface charge of A009 was significantly less negative than the one of A027. Using the C. elegans model, only A027(ind) strain showed a reduction on virulence. The diversity of polymyxin B resistance mechanisms among A. baumannii strains evaluated in this study confirms the complexity of these mechanisms, which may vary depending of the background of each strain.

  14. Acinetobacter baumannii Infection in the Neonatal Intensive Care Unit

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    AMK AL Jarousha

    2008-09-01

    Full Text Available Background: To perform a prospective case control study of blood stream infection to determine the infection rate of Acine­tobac­ter baumannii and the risk factors associated with mortality."nMethods:   From February 2004 to January 2005, 579 consecutive episodes of blood stream infection were obtained at two neo­na­tal intensive care units Al Nasser and Al Shifa hospitals in Gaza City. Forty (6.9% isolates of A. baumannii were ob­tained from the neonates under 28 d. Most of the isolates (92% were from hospitalized patients in the intensive care units."nResults: Community acquired infection was 8%.  Sixty three percent of the patients were males. The isolates of A. bauman­nii were resistant to commonly used antibiotics while being sensitive to meropenem (92.5%, imipenem (90%, chloram­pheni­col (80%, ciprofloxacin (75%, gentamicin (57.5%, ceftriaxone (50%, amikacin (37.5%, cefuroxime and ce­fo­taxime (35%. Over all crude mortality rate was 20% with much higher crude mortality among patients with noso­co­mial infec­tion.  Based on logistic regression, the following factors were statistically significant: weight < 1500g, age < 7 d, mean of hospitalization equal 20 days, antibiotic use, and mechanical ventilation, when compared to the control group (P< 0.05."nConclusion:  Infection rate of nosocomial blood stream infection was considerable and alarming in neonatal intensive care unit infants and associated with a significant excess length of NICU stay and a significant economic burden.  

  15. The influence of carbapenem resistance on mortality in solid organ transplant recipients with Acinetobacter baumannii infection

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    de Gouvêa Erika

    2012-12-01

    Full Text Available Abstract Background Infection with carbapenem-resistant Acinetobacter baumannii has been associated with high morbidity and mortality in solid organ transplant recipients. The main objective of this study was to assess the influence of carbapenem resistance and other potential risk factors on the outcome of A. baumannii infection after kidney and liver transplantation. Methods Retrospective study of a case series of A. baumannii infection among liver and renal transplant recipients. The primary outcome was death associated with A. baumannii infection. Multivariate logistic regression was used to assess the influence of carbapenem resistance and other covariates on the outcome. Results Forty-nine cases of A. baumannii infection affecting 24 kidney and 25 liver transplant recipients were studied. Eighteen cases (37% were caused by carbapenem-resistant isolates. There were 17 (35% deaths associated with A. baumannii infection. In unadjusted analysis, liver transplantation (p = 0.003, acquisition in intensive care unit (p = 0.001, extra-urinary site of infection (p A. baumannii infection. The number of deaths associated with A. baumannii infection was higher among patients infected with carbapenem-resistant isolates, but the difference was not significant (p = 0.28. In multivariate analysis, the risk of A. baumannii-associated mortality was higher in patients with infection acquired in the intensive care unit (odds ratio [OR] = 34.8, p = 0.01 and on mechanical ventilation (OR = 15.2, p = 0.04. Appropriate empiric antimicrobial therapy was associated with significantly lower mortality (OR = 0.04, p = 0.03, but carbapenem resistance had no impact on it (OR = 0.73, p = 0.70. Conclusion These findings suggest that A. baumannii-associated mortality among liver and kidney transplant recipients is influenced by baseline clinical severity and by the early start of appropriate therapy, but not by carbapenem

  16. Genome Sequences of Four Acinetobacter baumannii-A. calcoaceticus Complex Isolates from Combat-Related Infections Sustained in the Middle East

    Science.gov (United States)

    2014-02-06

    baumannii -A. calcoaceticus Complex Isolates from Combat-Related Infections Sustained in the Middle East Acinetobacter baumannii is among the most...responses make treatment difficult. Here, we report the genome sequences of four clinical Acinetobacter baumannii - A. calcoaceticus complex isolates... Acinetobacter baumannii , A. calcoaceticus, combat-related infections REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 10. SPONSOR/MONITOR’S

  17. Emergence of coryneforms in osteomyelitis and orthopaedic surgical site infections

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    Meher Rizvi

    2011-07-01

    Full Text Available BackgroundCoryneform species other than Corynebacterium diphtheriae are coming up as important pathogens with the potential to cause serious and life-threatening infections not only in immunocompromised but in immunocompetent individuals as well. The exact infectious potential of these bacteria and their rational antimicrobial treatment is a challenging but essential task.Method The study was conducted in the Department of Microbiology and the Department of Orthopaedics, JNMCH, AMU, Aligarh between August 2007 and May 2009. Pus samples were collected from patients of osteomyelitis and other bone infections including orthopaedic surgical site infections. The Corynebacterium species isolated in the study was identified using standard microbiological techniques and antimicrobial sensitivity testing was done by Kirby bauer disc diffusion method.ResultsA total of 312 Corynebacterium species were isolated. The majority of the coryneforms were isolated from the immunocompetent patients 270 (86.54%. C.jeikium was the most common coryneform isolated. Nearly half of the patients 153 (49.04% had acute infection caused by Corynebacterium species after orthopaedic surgery, a quarter 66 (21.15% had chronic infection and 72 (23.08% patients had device-related infection. Coryneforms exhibited maximum resistance to aminoglycosides (58.65% and β-lactams (penicillin group- 57.55%. C.jeikium was found to be the most resistant amongst all the Corynebacterium species.ConclusionThe study highlights the fact that the coryneforms are no longer just opportunistic pathogens but they are also becoming important pathogens among immunocompetent individuals as well. The emergence of drug resistance amongst these isolates is of most concern. More studies should be done on identification and on antimicrobial susceptibility of these organisms for the proper treatment of patients with such infections.

  18. Longitudinal Characterization of Acinetobacter baumannii-calcoaceticus Complex, Klebsiella pneumoniae, and Methicillin-Resistant Staphylococcus aureus Colonizing and Infecting Combat Casualties

    Science.gov (United States)

    2012-01-01

    Brief report Longitudinal characterization of Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae , and methicillin-resistant...resistant Acinetobacter baumannii-calcoaceticus complex Klebsiella pneumoniae Methicillin-resistant Staphylococcus aureus MRSA Drug-resistant...Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae , and methicillin- resistant Staphylococcus aureus colonize and infect combat casualties

  19. Susceptibility, phenotypes of resistance, and extended-spectrum β-lactamases in Acinetobacter baumannii strains

    Directory of Open Access Journals (Sweden)

    Elzbieta Tryniszewska

    2012-04-01

    Full Text Available Acinetobacter baumannii plays an increasing role in the pathogenesis of infections in humans. The bacilli are frequently isolated from patients treated in intensive care units. A growing resistance to antibiotics is leading to the emergence of strains that are multidrug-resistant and resistant to all available agents. The objective of this study was to assess susceptibility to antibiotics and to determine the presence and current level of the extended-spectrum β-lactamases (ESBLs and attempt to isolate the Acinetobacter baumannii strain carrying the blaPER gene. A total of 51 strains of A. baumannii identified by phenotypic features were examined. That the strains belonged to the species was confirmed by the presence of the blaOXA-51-like; gene. A broth microdilution method was used for antibacterial susceptibility testing. The occurrence of ESBLs was determined using phenotypic double-disk synergy tests. The PCR technique was used to confirm the presence of the blaPER-1; gene encoding ESBL. The most active antibiotics were meropenem, cefepime and ampicillin/sulbactam, with susceptibility shown by 76.5%, 60.8% and 56.9% of the strains, respectively. The strains exhibited the highest resistance (> 75% to piperacillin, tetracycline, ciprofloxacin and cefotaxime. Phenotypic tests revealed ESBL mechanism of resistance in approximately 20% of Acinetobacter baumannii isolates. However, the PCR technique did not confirm the presence of the blaPER-1; gene in any of the Acinetobacter baumannii strains examined in our hospital. Acinetobacter baumannii strains demonstrate considerable resistance to many groups of antibiotics. Our findings indicate the involvement of enzymes belonging to families other than PER β-lactamase in resistance to β-lactams in A. baumannii.

  20. OmpA Binding Mediates the Effect of Antimicrobial Peptide LL-37 on Acinetobacter baumannii.

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    Ming-Feng Lin

    Full Text Available Multidrug-resistant Acinetobacter baumannii has recently emerged as an important pathogen in nosocomial infection; thus, effective antimicrobial regimens are urgently needed. Human antimicrobial peptides (AMPs exhibit multiple functions and antimicrobial activities against bacteria and fungi and are proposed to be potential adjuvant therapeutic agents. This study examined the effect of the human cathelicidin-derived AMP LL-37 on A. baumannii and revealed the underlying mode of action. We found that LL-37 killed A. baumannii efficiently and reduced cell motility and adhesion. The bacteria-killing effect of LL-37 on A. baumannii was more efficient compared to other AMPs, including human ß-defensin 3 (hBD3 and histatin 5 (Hst5. Both flow cytometric analysis and immunofluorescence staining showed that LL-37 bound to A. baumannii cells. Moreover, far-western analysis demonstrated that LL-37 could bind to the A. baumannii OmpA (AbOmpA protein. An ELISA assay indicated that biotin-labelled LL-37 (BA-LL37 bound to the AbOmpA74-84 peptide in a dose-dependent manner. Using BA-LL37 as a probe, the ~38 kDa OmpA signal was detected in the wild type but the ompA deletion strain did not show the protein, thereby validating the interaction. Finally, we found that the ompA deletion mutant was more sensitive to LL-37 and decreased cell adhesion by 32% compared to the wild type. However, ompA deletion mutant showed a greatly reduced adhesion defect after LL-37 treatment compared to the wild strain. Taken together, this study provides evidence that LL-37 affects A. baumannii through OmpA binding.

  1. The Antibacterial Activity Evaluation of the Nanoparticles of Silver on Acinetobacter Baumannii

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    Seyedeh Nasim Karimipour

    2016-09-01

    Full Text Available Background & Objective: Due to the high drug resistance in Acinetobacter baumannii, in this research, antibacterial properties of nano silver was evaluated for Acinetobacter baumannii. Materials & Methods: The nano silver with approximate diameter of 20 nanometer from Pishtazan Inc. Mashad, Iran and 5 nanometer from the Department of Chemistry in Maragheh University were prepared. Its concentration was determined by spectroscopy method in Tabriz Chemistry University.  Antimicrobial effects were determined by Mean Inhibitory Concentration (MIC and Minimal Bacterial Concentration (MBC by micro-broth-dilution method, disc diffusion and well diffusion methods. Anti-bacterial activity of nano-silver was tested for Acinetobacter baumannii NCTC12516 on 20 clinical strains (collected from Imam Reza Hospital in Tabriz. Results: The results showed the MIC and MBC of 20nm nanoparticles were 1250 ppm and 2500 ppm, respectively. On the other hand, the MIC and MBC of 5 nm nanoparticles were 156 ppm and 312 ppm, respectively. According to these findings, the MIC and MBC identified for clinical Acinetobacter baumannii strains under study along with the NCTC12516 strain did not show a significant difference. Yet the amount of inhibition for the 20nm nanoparticles in the density of 20000 ppm of clinical Acinetobacter baumannii and NCTC12516 strains was 11 millimeter with the disc diffusion method and 9.5 millimeter for the well diffusion method with the same concentration. The amount of inhibition of 5nm nanoparticles in the 250-ppm concentration with both disc diffusion and well diffusion methods was 9.5 millimeter. Conclusions: Acinetobacter baumannii is susceptible to nano-silver. Also the same MIC and MBC in multiple clinical strains suggests that there is not resistance to silver nanoparticles in Acinetobacter baumannii

  2. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline

    Energy Technology Data Exchange (ETDEWEB)

    Newman, L.G.; Waller, J.; Palestro, C.J.; Schwartz, M.; Klein, M.J.; Hermann, G.; Harrington, E.; Harrington, M.; Roman, S.H.; Stagnaro-Green, A. (Mount Sinai Medical Center, New York, NY (USA))

    1991-09-04

    The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. The authors therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. They compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. Consecutive samples were obtained from 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. The recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis.

  3. Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis

    NARCIS (Netherlands)

    Kluin, Otto S.; van der Mei, Henny C.; Busscher, Henk J.; Neut, Danielle

    2013-01-01

    Introduction: Chronic osteomyelitis, or bone infection, is a major worldwide cause of morbidity and mortality, as it is exceptionally hard to treat due to patient and pathogen-associated factors. Successful treatment requires surgical debridement together with long-term, high antibiotic concentratio

  4. Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report.

    Science.gov (United States)

    Dornbos, David; Morin, Jocelyn; Watson, Joshua R; Pindrik, Jonathan

    2016-12-01

    Osteomyelitis of the spine with associated spinal epidural abscess represents an uncommon entity in the pediatric population, requiring prompt evaluation and diagnosis to prevent neurological compromise. Cat scratch disease, caused by the pathogen Bartonella henselae, encompasses a wide spectrum of clinical presentations; however, an association with osteomyelitis and epidural abscess has been reported in only 4 other instances in the literature. The authors report a rare case of multifocal thoracic osteomyelitis with an epidural abscess in a patient with a biopsy-proven pathogen of cat scratch disease. A 5-year-old girl, who initially presented with vague constitutional symptoms, was diagnosed with cat scratch disease following biopsy of an inguinal lymph node. Despite appropriate antibiotics, she presented several weeks later with recurrent symptoms and back pain. Magnetic resonance imaging revealed 2 foci of osteomyelitis at T-8 and T-11 with an associated anterior epidural abscess from T-9 to T-12. Percutaneous image-guided vertebral biopsy revealed B. henselae by polymerase chain reaction analysis, and she was treated conservatively with doxycycline and rifampin with favorable clinical outcome.

  5. Fusarium Osteomyelitis in a Patient With Pearson Syndrome: Case Report and Review of the Literature

    Science.gov (United States)

    Hiebert, Rachael M.; Welliver, Robert C.; Yu, Zhongxin

    2016-01-01

    Fusarium species are ubiquitous fungi causing a wide array of infections, including invasive disease in the immunosuppressed. We present a fusarium bone infection in a child with Pearson syndrome and review the literature. Ten cases of fusarium osteomyelitis were reported in the past 40 years, and we review the treatments. PMID:27757410

  6. Non-infectious osteomyelitis of the mandible in a young woman

    DEFF Research Database (Denmark)

    Rasmussen, Anne Q; Andersen, Ulrik B; Jørgensen, Niklas R

    2014-01-01

    after 12 months. The bone pain was significantly reduced six months after treatment and had disappeared 24 months after treatment. CONCLUSION: We report an unusual localization of non-infectious osteomyelitis of the jaw in a young woman. Even though the presentation was in the jaw, her condition...

  7. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

    2009-07-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  8. Influence of the location of nonischemic diabetic forefoot osteomyelitis on time to healing after undergoing surgery.

    Science.gov (United States)

    Cecilia-Matilla, Almudena; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Álvarez, Yolanda; Chana-Valero, Pedro; Beneit-Montesinos, Juan Vicente

    2013-09-01

    The forefoot has been reported as the most frequent location of osteomyelitis in the feet of patients with diabetes. The forefoot includes toes and metatarsal heads as common locations of bone infections, but the anatomy of these bones is quite different. As a result, such differences in anatomy may have an impact on the outcomes. The aim of the present study was to determine whether different locations of osteomyelitis in the forefoot have any influence on time to healing after undergoing surgery in a prospective series including 195 patients without peripheral arterial disease and osteomyelitis confirmed by histopathology. Location of the lesion was classified into 4 groups: hallux, first metatarsal head, lesser metatarsal heads, and lesser toes. The time required to achieve healing and the cumulative rate of wounds healed and likelihood of healing were analyzed at 4, 8, and 12 weeks after surgery. Time of healing (mean ± SD) in the whole series was 10.7 ± 8.4 weeks. Osteomyelitis located in the lesser toes has a higher probability of healing by the fourth week (odds ratio [OR] = 5.7, 95% confidence interval [CI] = 2.8-11.6, P forefoot.

  9. A novel observation of pubic osteomyelitis due to Streptococcus viridans after dental extraction: a case report

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    Naqvi Naseem

    2008-07-01

    Full Text Available Abstract Introduction Pubic osteomyelitis should be suspected in athletic individuals with sudden groin pain, painful restriction of hip movements and fever. It is an infrequent and confusing disorder, which is often heralded by atypical gait disturbance and diffuse pain in the pelvic girdle. The most common pathogen is Staphylococcus aureus but, on occasions, efforts to identify infectious agents sometimes prove negative. Pubic osteomyelitis due to Streptococcus viridans has not been reported previously in the literature. Case presentation We describe the case of a fit 24-year-old athlete, who had a wisdom tooth extracted 2 weeks prior to the presentation, which could have served as a port of entry and predisposed the patient to transient bacteraemia. Conclusion S. viridans is well known for causing infective endocarditis of native damaged heart valves, but to the best of the authors' knowledge it has not been reported previously as a cause of pubic osteomyelitis. We believe that this case should alert physicians to the association between dental procedures and osteomyelitis of the pubis secondary to S. viridans.

  10. Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques

    Energy Technology Data Exchange (ETDEWEB)

    Keenan, A.M.; Tindel, N.L.; Alavi, A. (Hospital of the Univ. of Pennsylvania, Philadelphia (USA))

    1989-10-01

    Seventy-seven diabetic patients with suspected osteomyelitis of the foot were evaluated by three-phase bone scintigraphy (TPBS), indium 111-labeled white blood cell scintigraphy (WBCS), roentgenography, or some combination thereof. Retrospective analysis after clinical and pathologic follow-up indicated that the sensitivity of TPBS alone in the diagnosis of osteomyelitis was 100%, with a specificity of only 38% and an accuracy of 63%; the sensitivity of WBCS alone was 100%, with a specificity of 78% and an accuracy of 87%; and the combination of TPBS and WBCS yielded a sensitivity of 100%, with a specificity of 79% and an accuracy of 87%. Roentgenography yielded a sensitivity of 69%, with a specificity of 82% and an accuracy of 76%. The results of this study demonstrate that WBCS is superior to TPBS in the diagnosis of osteomyelitis in the diabetic foot, and TPBS adds little when viewed in conjunction with WBCS. Based on our observations and because of the high prevalence of neuropathic joint disease and other causes of false-positive bone scans, we believe that WBCS alone is adequate for evaluation of suspected pedal osteomyelitis in diabetic patients, particularly when the suspected lesion is located in the tarsometatarsal region in contrast to the toe region (7% vs 44% specificity and 28% vs 69% accuracy, respectively, for TPBS in these two regions, compared with 100% vs 68% specificity and 100% vs 80% accuracy, respectively, for WBCS in the same two regions).

  11. [Importance of bone scanning and osteoscintimetry for assessing development of acute haematogenic childhood osteomyelitis (author's transl)].

    Science.gov (United States)

    Fotter, R; Höllwarth, M

    1980-01-01

    Bone scanning with 99m-Tc-MDP is generally used for the early diagnosis of acute haematogenic childhood osteomyelitis. The combination of this method with radionuclide osteoscintimetry and the evaluation of the relative uptake ratio supply objective criteria for assessing the development of the disease. They permit statements as to the morphological and functional aspects of the disease and thus facilitate clinical assessment.

  12. Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis.

    LENUS (Irish Health Repository)

    Kennedy, M T

    2012-06-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.

  13. Clinical, morphological, and molecular characterization of Penicillium canis, sp. nov., isolated from a dog with osteomyelitis

    Science.gov (United States)

    Infections caused by Penicillium spp. are rare in dogs, and the prognosis in these cases is poor. An unknown species of Penicillium was isolated from a bone lesion in a young dog with osteomyelitis of the right ilium. Extensive diagnostic evaluation did not reveal evidence of dissemination. Resoluti...

  14. Actinobacillus pleuropneumoniae osteomyelitis in pigs demonstrated by fluorescent in situ hybridization

    DEFF Research Database (Denmark)

    Jensen, Tim Kåre; Boye, Mette; Hagedorn-Olsen, T.;

    1999-01-01

    Necrotizing osteomyelitis and fibrinopurulent arthritis with isolation of Actinobacillus pleuropneumoniae serotype 2 is reported in two pigs from a herd with lameness and mild coughing problems among 8 to 12-week-old pigs. Application of fluorescent in situ hybridization targeting 16S ribosomal RNA...

  15. Fusarium falciforme vertebral abscess and osteomyelitis: case report and molecular classification

    Science.gov (United States)

    Fusarium is a ubiquitous filamentous mold that rarely causes disease in immunocompetent humans but can be fatal in immunocompromised hosts. We report an unusual case of vertebral abscess and osteomyelitis in a patient with an autoimmune disorder who was on long term glucocorticoids. Multilocus DNA s...

  16. Posttraumatic tuberculous osteomyelitis of the foot-A rare case report

    Institute of Scientific and Technical Information of China (English)

    Gauresh Vargaonkar; P.Sathyamurthy; Varun Kumar Singh; Sunil Mallojwar

    2015-01-01

    Skeletal tuberculosis developing after trauma is a rare occurrence.We report a rare case of posttraumatic tubercular osteomyelitis of mid-tarsal bone of the right foot.Patient was treated with regular dressing and anti-tubercular drugs.Posttraumatic skeletal tuberculosis should be considered in patient with nonhealing ulcer.

  17. Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature.

    Science.gov (United States)

    Khan, Kamran; Wozniak, Susan E; Mehrabi, Erfan; Giannone, Anna Lucia; Dave, Mitul

    2015-12-28

    BACKGROUND Sternoclavicular osteomyelitis is a rare disease, with less than 250 cases identified in the past 50 years. We present a rare case of sternoclavicular osteomyelitis in an immunosuppressed patient that developed from a conservatively treated dislocation. CASE REPORT A 62-year-old white man with a history of metastatic renal cell carcinoma presented to the emergency department (ED) with a dislocated left sternoclavicular joint. He was managed conservatively and subsequently discharged. However, over subsequent days he began to experience pain, fever, chills, and night sweats. He presented to the ED again and imaging revealed osteomyelitis. In the operating room, the wound was aggressively debrided and a wound vac (vacuum-assisted closure) was placed. He was diagnosed with sternoclavicular osteomyelitis and placed on a 6-week course of intravenous Nafcillin. CONCLUSIONS Chemotherapy patients who sustain joint trauma normally associated with a low risk of infection should be monitored thoroughly, and the option to discontinue immunosuppressive therapy should be considered if signs of infection develop.

  18. Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Shariff Sajid

    2010-02-01

    Full Text Available Abstract Introduction Cases of acute tarsal tunnel syndrome are rare. To the best of our knowledge, we describe the only reported case of acute posterior tibial nerve compression resulting from adjacent haemotogenous pyogenic calcaneal osteomyelitis. Case presentation A previously healthy 38-year-old Caucasian woman developed symptoms of acute tarsal tunnel syndrome in her right foot over a six-day period. No antecedent trauma or systemic symptoms were noted. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of Staphylococcus aureus calcaneal osteomyelitis. Her pain and paraesthesia disappeared after the operation, while her inflammatory markers normalised during a 12-week course of antibiotics. After four years she has remained asymptomatic without any indication of recurrence. Conclusion This case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, because haemotogenous calcaneal osteomyelitis is in itself a rare pathology. We recommend considering infection as a differential diagnosis in patients presenting with acute tarsal tunnel syndrome.

  19. [Treatment of osteomyelitis with oral bactericidal antibiotics-- description of 9 cases].

    Science.gov (United States)

    Major, S; Chuard, C; Regamey, C

    1996-01-27

    The efficacy of oral bactericidal antibiotics in the treatment of osteomyelitis is analyzed retrospectively by a review of 9 cases histories. The first patient was treated in 1982. Clinical and laboratory controls were reviewed up to 1.1.1995. In 6 patients S. aureus was isolated, while in 3 patients the organism could not be cultured but gram + cocci were almost likely. 5 cases of osteomyelitis were acute, 4 were chronic and in one case there was an infection of an artificial knee prothesis. The isolated S. aureus were sensitive to the antibiotics prescribed. 8 patients received a combination of flucloxacillin (2-4 g/day) and rifampicin (600 mg/day); one patient was treated with the combination amoxicillin/clavulanic acid (1500/425 mg/day) followed by ofloxacin (400 mg/day) and finally co-trimoxazole (320/1600 mg/day). 3 patients received all antibiotics orally; in 6 patients oral administration followed a short intravenous course of the antibiotic combination. The duration of treatment varied between 6 and 23 weeks. Follow-up extended over 9 months (n = 1), 14 months (n = 3), 4-7 years (n = 3), and 10-12 years (n = 2). In 8 cases the osteomyelitis was cured (89%). In our view, a combination of bactericidal oral antibiotics with good penetration into bone tissue can be prescribed in selected cases of osteomyelitis to shorten or even avoid the standard intravenous therapy of acute or chronic diseases.

  20. Efficacy of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with osteomyelitis.

    Science.gov (United States)

    Kelly, Kristi R; Kapatkin, Amy R; Zwingenberger, Allison L; Christe, Kari L

    2012-08-01

    Here we describe the successful surgical implementation of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with marked osteomyelitis. The macaque presented to the veterinary clinic with grossly contaminated bite wounds in the left ankle secondary to conspecific trauma. Radiographic findings were highly suggestive of osteomyelitis. Additional differential diagnoses included bony infarct, fracture, and cellulitis. In light of the location of the lesion and extensive tissue trauma, the animal had a poor prognosis. Systemic, broad-spectrum antibiotics were instituted. After 2 wk of care, lesions did not respond to empirical therapies. On consultation, a veterinary orthopedic surgeon at another facility recommended placement of antibiotic-impregnated polymethylmethacrylate beads at the sites of osteomyelitis. The animal underwent minor surgery in which beads were introduced into the wound. The monkey had a positive response to therapy. The animal regained full function and was returned to outdoor social housing. Veterinarians are encouraged to consider using antibiotic-impregnated polymethylmethacrylate beads when treating osteomyelitis in other nonhuman primates and in other traditional laboratory animal species.

  1. Th17 cytokine deficiency in patients with Aspergillus skull base osteomyelitis

    NARCIS (Netherlands)

    Delsing, C.E.; Becker, K.L.; Simon, A.; Kullberg, B.J.; Bleeker-Rovers, C.P.; Veerdonk, F.L. van de; Netea, M.G.

    2015-01-01

    BACKGROUND: Fungal skull base osteomyelitis (SBO) is a severe complication of otitis externa or sinonasal infection, and is mainly caused by Aspergillus species. Here we investigate innate and adaptive immune responses in patients with Aspergillus SBO to identify defects in the immune response that

  2. Rapid discrimination of Acinetobacter baumannii international clone II lineage by pyrosequencing SNP analyses of bla(OXA-51-like) genes.

    Science.gov (United States)

    Matsui, Mari; Suzuki, Satowa; Suzuki, Masato; Arakawa, Yoshichika; Shibayama, Keigo

    2013-08-01

    We found that Acinetobacter baumannii international clone II generally possesses unique GTA sequence at nucleotide positions 106-108 in the bla(OXA-51-like) genes. We exploited this to develop an easy and rapid method for discrimination of international clone II from other A. baumannii by employing pyrosequencing analyses of single nucleotide polymorphisms.

  3. Whole-genome pyrosequencing of an epidemic multidrug-resistant Acinetobacter baumannii strain belonging to the European clone II group

    DEFF Research Database (Denmark)

    Iacono, M.; Villa, L.; Fortini, D.

    2008-01-01

    The whole-genome sequence of an epidemic, multidrug-resistant Acinetobacter baumannii strain (strain ACICU) belonging to the European clone II group and carrying the plasmid-mediated bla(OXA-58) carbapenem resistance gene was determined. The A. baumannii ACICU genome was compared with the genomes...

  4. A multidisciplinary approach for the treatment of complication of hematogenous osteomyelitis in children

    Directory of Open Access Journals (Sweden)

    Юрий Евгеньевич Гаркавенко

    2016-06-01

    Full Text Available Background.Severe orthopedic complications of osteomyelitis occurred in 22%–71.2% of children with osteomyelitis in previous studies. At the same time 26.5% of children with complications of osteomyelitis, according to data of The Turner Scientific and Research Institute for Children’s Orthopedics, have multiple bone lesions. The challenges involved in the orthopedic treatment of musculoskeletal system disorders are diverse and complex. In some cases, inadequate attention is paid to the need to treat the facial bones of the skull, temporomandibular joint (TMJ, and jaw bones.Aim.The aim of this paper is to demonstrate the need for a variety of options and to determine the best strategies for comprehensive medical rehabilitation, involving orthopedic and maxillofacial surgeons and other healthcare providers, for children with complications of osteomyelitis, who had destruction of the long tubular bones of the jaw.Materials and methods.Between 2011 and 2015 26 children (10 males and 16 females aged 1.5–17 years with multiple localized lesions after osteomyelitis were treated in The Turner Scientific and Research Institute for Children’s Orthopedic. In addition to severe orthopedic disorders, there has been a loss of TMJ, which resulted in severe functional impairment and impaired development of the facial bones of the skull.Results.There was a individualized approach to the treatment of pediatric patients with complications of osteomyelitis. Early diagnosis and proper treatment prevented severe changes in the musculoskeletal system and maxillofacial area in pediatric patients.Conclusion.The modern concept of comprehensive medical rehabilitation of children with complications of osteomyelitis should include an interdisciplinary approach involving orthopedic and maxillofacial surgeons. Early diagnosis in children ensures the timely formation of individualized rehabilitation programs, designed to improve the anatomical and functional

  5. Protection against Acinetobacter baumannii infection via its functional deprivation of biofilm associated protein (Bap).

    Science.gov (United States)

    Fattahian, Yaser; Rasooli, Iraj; Mousavi Gargari, Seyed Latif; Rahbar, Mohammad Reza; Darvish Alipour Astaneh, Shakiba; Amani, Jafar

    2011-12-01

    Acinetobacter baumannii, a major nosocomial pathogen, has remarkable capacity to acquire antimicrobial resistance attributable to its biofilm formation ability. Biofilm associated protein (Bap), a specific cell surface protein, is directly involved in biofilm formation by A. baumannii and plays a major role in bacterial infectious processes. In the present study we cloned, expressed and purified a 371 amino acid subunit of Bap. Mice were immunized using recombinant Bap subunit. They were then challenged with A. baumannii to evaluate the immunogenicity and protectivity of Bap subunit. Humoral immune response to Bap was determined by ELISA. Injection of Bap subunit resulted in high antibody titers. Decrease in bacterial cell counts of the immunized mice was evident 18 h after challenge. Reaction of antibodies against Bap with several strains suggests that not only immunodominant regions of Bap in A. baumannii strains are conserved but also have the same epitope presenting pattern in different strains. Immunodominant region of Bap possesses target sites for a protective humoral immune response to A. baumannii. This seems to be a conserved region erecting efficacy of Bap as an appropriate vaccine candidate.

  6. Emergence of resistance to carbapenems in Acinetobacter baumannii in Europe: clinical impact and therapeutic options.

    Science.gov (United States)

    Kempf, Marie; Rolain, Jean-Marc

    2012-02-01

    Despite having a reputation of low virulence, Acinetobacter baumannii is an emerging multidrug-resistant (MDR) pathogen responsible for community- and hospital-acquired infections that are difficult to control and treat. Interest in this pathogen emerged about one decade ago because of its natural MDR phenotype, its capability of acquiring new mechanisms of resistance and the existence of nosocomial outbreaks. Recent advances in molecular biology, including full genome sequencing of several A. baumannii isolates, has led to the discovery of the extraordinary plasticity of their genomes, which is linked to their great propensity to adapt to any environment, including hospitals. In this context, as well as the increasing antimicrobial resistance amongst A. baumannii isolates to the last-line antibiotics carbapenems and colistin, therapeutic options are very limited or absent in some cases of infections with pandrug-resistant bacteria. However, a large proportion of patients may be colonised by such MDR bacteria without any sign of infection, leading to a recurrent question for clinicians as to whether antibiotic treatment should be given and will be effective in the presence of resistance mechanisms. The worldwide emergence of A. baumannii strains resistant to colistin is worrying and the increasing use of colistin to treat infections caused by MDR bacteria will inevitably increase the recovery rate of colistin-resistant isolates in the future. Current knowledge about A. baumannii, including biological and epidemiological aspects as well as resistance to antibiotics and antibiotic therapy, are reviewed in this article, in addition to therapeutic recommendations.

  7. [The review of carbapenem resistance in clinical isolates of Acinetobacter baumannii].

    Science.gov (United States)

    Goić-Barisić, Ivana; Tonkić, Marija

    2009-10-01

    Increasing reports of Acinetobacter infections that cause pneumonia, meningitis, endocarditis, and bacteriaemia underline the clinical importance of this pathogen. Members of the genus Acinetobacter, particularly Acinetobacter baumannii, are now recognized as significant nosocomial pathogens, particularly for the subset of critically-ill patients requiring mechanical ventilation in hospital intensive care units. A. baumannii has itself a quite high level of naturally-occurring antibiotic resistance. The organism can survive for long periods in the hospital environment including dry and humid areas. One of the most worrying antibiotic resistance problems in A. baumannii is the increasing trend of carbapenem resistance, present also in few Croatian hospitals. Infections caused by this Gram-negative bacillus are common in the intensive care units anticipated by colonized patients. The increasing trend of carbapenem resistance in A. baumannii could be mediated from metallo-beta-lactamases (VIM, IMP, and SIM), carbapenem-hydrolyzing oxacillinases (OXA), porin modifications for influx of carbapenems (33-kDa CarO protein) and/or often combined mechanisms of resistance. The investigation of the background of carbapenem resistance in relevant clinical isolates of A. baumannii from Split University Hospital confirmed present of carbapenem-hydrolyzing oxacillinases OXA-107 representing a more recent evolutionary adaptation OXA-51-like enzyme to antibiotic challenge with carbapenems.

  8. Outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit.

    Science.gov (United States)

    Dettori, Marco; Piana, Andrea; Deriu, Maria Grazia; Lo Curto, Paola; Cossu, Andrea; Musumeci, Rosario; Cocuzza, Clementina; Astone, Vito; Contu, Maria Antonietta; Sotgiu, Giovanni

    2014-04-01

    Acinetobacter baumannii is a ubiquitous microrganism often able to colonize and survive in different environments. Currently it is one of the most common pathogens responsible for nosocomial infections, including outbreaks, especially in long-term care facilities. The aim of this study was to show the results of an environmental investigation and genotyping analysis of multidrug-resistant Acinetobacter baumannii associated with an outbreak in an intensive care unit of a tertiary hospital located in Northern Sardinia, Italy. Positive cultures of MDR Acinetobacter baumannii were reported during the month of June 2012, after the collection of biological samples from ten patients. Acinetobacter baumannii was isolated during the following environmental investigation from the headboard of two beds. All the strains were genotyped by performing multiplex PCR to identify the presence of genes encoding carbapenemases. The results showed specific bands of bla(OXA-51-like) gene and of the bla(OXA-23-like) gene. PFGE highlighted minimal differences in genomic fingerprints, while the cluster analysis grouped the isolated microorganisms into two closely related clusters, characterized by Dice's similarity coefficient equal to 95.1%. MLST showed that the strains belonged to ST31. The results of the study highlight the need, especially in high-risk areas, to adopt strict hygiene practices, particularly hand hygiene, and to ensure an appropriate turnover of personal protective equipment, which could be responsible for the spread of biological agents, such as MDR Acinetobacter baumannii.

  9. Antibiotic Resistance Determinant-Focused Acinetobacter baumannii Vaccine Designed Using Reverse Vaccinology

    Science.gov (United States)

    Ni, Zhaohui; Chen, Yan; Ong, Edison; He, Yongqun

    2017-01-01

    As one of the most influential and troublesome human pathogens, Acinetobacter baumannii (A. baumannii) has emerged with many multidrug-resistant strains. After collecting 33 complete A. baumannii genomes and 84 representative antibiotic resistance determinants, we used the Vaxign reverse vaccinology approach to predict classical type vaccine candidates against A. baumannii infections and new type vaccine candidates against antibiotic resistance. Our genome analysis identified 35 outer membrane or extracellular adhesins that are conserved among all 33 genomes, have no human protein homology, and have less than 2 transmembrane helices. These 35 antigens include 11 TonB dependent receptors, 8 porins, 7 efflux pump proteins, and 2 fimbrial proteins (FilF and CAM87009.1). CAM86003.1 was predicted to be an adhesin outer membrane protein absent from 3 antibiotic-sensitive strains and conserved in 21 antibiotic-resistant strains. Feasible anti-resistance vaccine candidates also include one extracellular protein (QnrA), 3 RND type outer membrane efflux pump proteins, and 3 CTX-M type β-lactamases. Among 39 β-lactamases, A. baumannii CTX-M-2, -5, and -43 enzymes are predicted as adhesins and better vaccine candidates than other β-lactamases to induce preventive immunity and enhance antibiotic treatments. This report represents the first reverse vaccinology study to systematically predict vaccine antigen candidates against antibiotic resistance for a microbial pathogen. PMID:28230771

  10. Nosocomial imipenem-resistant Acinetobacter baumannii infections: epidemiology and risk factors.

    Science.gov (United States)

    Dizbay, Murat; Tunccan, Ozlem Guzel; Sezer, Busra Ergut; Hizel, Kenan

    2010-10-01

    The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of nosocomial imipenem-resistant A. baumannii (IRAB) infections during a 5-y period (2003-2007) were retrospectively analyzed. A total of 720 patients with 925 episodes of A. baumannii infection were included in the study. A. baumannii infections were seen mostly in intensive care units. The incidence was 6.2 per 1000 admissions. The most common infections were pneumonias and bloodstream infections. Imipenem resistance among Acinetobacter strains increased significantly each y of the study (from 43.3% to 72.9%). Mortality was related to the presence of imipenem resistance, stay in intensive care unit, female gender, old age, and pneumonia. Haemodialysis, malignancy, and mechanical ventilation were significant risk factors for IRAB infections. Imipenem resistance was higher in strains isolated from patients with pneumonia. IRAB strains showed higher resistance rates to other antibiotics than imipenem-susceptible strains. The most active antimicrobial agents against A. baumannii were cefoperazone-sulbactam and netilmicin. The incidence of A. baumannii infections and imipenem resistance increased during the study period. IRAB infections should be considered in patients on mechanical ventilation and haemodialysis and in patients with malignancies.

  11. Modeling the impact of interventions against Acinetobacter baumannii transmission in intensive care units.

    Science.gov (United States)

    Doan, Tan N; Kong, David C M; Marshall, Caroline; Kirkpatrick, Carl M J; McBryde, Emma S

    2016-01-01

    The efficacy of infection control interventions against Acinetobacter baumannii remains unclear, despite such information being critical for effective prevention of the transmission of this pathogen. Mathematical modeling offers an alternative to clinical trials, which may be prohibitively expensive, unfeasible or unethical, in predicting the impact of interventions. Furthermore, it allows the ability to ask key "what if" questions to evaluate which interventions have the most impact. We constructed a transmission dynamic model to quantify the effects of interventions on reducing A. baumannii prevalence and the basic reproduction ratio (R0) in intensive care units (ICUs). We distinguished between colonization and infection, and incorporated antibiotic exposure and transmission from free-living bacteria in the environment. Under the assumptions and parameterization in our model, 25% and 18% of patients are colonized and infected with A. baumannii, respectively; and R0 is 1.4. Improved compliance with hand hygiene (≥87%), enhanced environmental cleaning, reduced length of ICU stay of colonized patients (≤ 10 days), shorter durations of antibiotic treatment of A. baumannii (≤6 days), and isolation of infected patients combined with cleaning of isolation rooms are effective, reducing R0 to below unity. In contrast, expediting the recovery of the intestinal microbiota (e.g. use of probiotics) is not effective. This study represents a biologically realistic model of the transmission dynamics of A. baumannii, and the most comprehensive analysis of the effectiveness of interventions against this pathogen. Our study provides important data for designing effective infection control interventions.

  12. In vitro sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems among intensive care unit patients.

    Science.gov (United States)

    Guzek, A; Korzeniewski, K; Nitsch-Osuch, Aneta; Rybicki, Z; Prokop, E

    2013-01-01

    Acinetobacter baumannii and Pseudomonas aeruginosa pathogens are the most common causes of fatal pneumonia among patients treated in Intensive Care Units (ICU). Carbapenems remain a group of antibiotics characterized by the highest effectiveness in treatment of heavy infections of the lower respiratory tract. This study compared in vitro sensitivity of A. baumannii and P. aeruginosa to three carbapenems: imipenem, meropenem and doripenem. The material was collected from 71 patients treated in the ICU from April 2009 to January 2010. Bronchial tree was the predominant source of samples. Fifty-four strains of A. baumannii and 17 strains of P. aeruginosa were analyzed. Sensitivity to carbapenems was interpreted in line with Clinical and Laboratory Standard Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria (imipenem and meropenem) or in compliance with the Food and Drug Administration (FDA) and CLSI guidelines (doripenem). We found that A. baumannii was significantly more often sensitive to imipenem than to doripenem and meropenem, but only according to the CLSI and FDA and not EUCAST criteria. The sensitivity of P. aeruginosa was higher to imipenem than to doripenem and meropenem, according to both CLSI and EUCAST criteria (64.7 %). We conclude that the EUCAST criteria demonstrate a higher rigor than those of CLSI and FDA in the determination of carbapenems sensitivity. Imipenem appears more effective than doripenem and meropenem in treatment of A. baumannii and P. aeruginosa infections.

  13. Colistin Resistance in Acinetobacter baumannii MDR-ZJ06 Revealed by a Multiomics Approach

    Science.gov (United States)

    Hua, Xiaoting; Liu, Lilin; Fang, Youhong; Shi, Qiucheng; Li, Xi; Chen, Qiong; Shi, Keren; Jiang, Yan; Zhou, Hua; Yu, Yunsong

    2017-01-01

    Acinetobacter baumannii has emerged as an important opportunistic pathogen due to its ability to acquire resistance to most currently available antibiotics. Colistin is often considered as the last line of therapy for infections caused by multidrug-resistant A. baumannii (MDRAB). However, colistin-resistant A. baumannii strain has recently been reported. To explore how multiple drug-resistant A. baumannii responded to colistin resistance, we compared the genomic, transcriptional and proteomic profile of A. baumannii MDR-ZJ06 to the induced colistin-resistant strain ZJ06-200P5-1. Genomic analysis showed that lpxC was inactivated by ISAba1 insertion, leading to LPS loss. Transcriptional analysis demonstrated that the colistin-resistant strain regulated its metabolism. Proteomic analysis suggested increased expression of the RND efflux pump system and down-regulation of FabZ and β-lactamase. These alterations were believed to be response to LPS loss. In summary, the lpxC mutation not only established colistin resistance but also altered global gene expression. PMID:28275586

  14. In Vitro Activity of Tigecycline Against Acinetobacter baumannii: Global Epidemiology and Resistance Mechanisms.

    Science.gov (United States)

    Pournaras, Spyros; Koumaki, Vasiliki; Gennimata, Vasiliki; Kouskouni, Evangelia; Tsakris, Athanassios

    2016-01-01

    Acinetobacter baumannii is a pathogen of increasing concern, commonly causing outbreaks in the hospital environment. Of particular concern, A. baumannii strains exhibiting resistance to carbapenems, which were previously considered the treatment of choice for infected patients, have dramatically increased worldwide, leaving a few antibacterial choices. Tigecycline, a broad-spectrum modified minocycline derivative, isconsidered as a last resort drug against multidrug-resistant A. baumannii. Though, resistance to tigecycline has emerged and is growing notably following increasing tigecycline usage. Comparative evaluation of the tigecycline resistance rates reported worldwide is challenging due to the absence of official interpretative criteria for in vitro susceptibility testing and the discrepancies among the different susceptibility methodologies used, with broth microdilution being considered the reference method. Tigecycline resistance is mainly associated with resistance-nodulation-cell division (RND)-type transporters, mainly the AdeABC, AdeFGH and AdeIJK efflux pumps, but other resistance mechanisms have also been implicated. Tigecycline is still an attractive choice for A. baumannii, but further investigations are warranted so that treatment of MDR Α. baumannii could be guided by validated in vitro data.

  15. Contribution of EmrAB efflux pumps to colistin resistance in Acinetobacter baumannii.

    Science.gov (United States)

    Lin, Ming-Feng; Lin, Yun-You; Lan, Chung-Yu

    2017-02-01

    Efflux pumps play an important role in antimicrobial resistance for Acinetobacter baumannii. However, the function of the Emr pump system and the relationship between Emr and drug resistance has not been characterized in A. baumannii. In this study, four possible groups of emr-like genes were found by searching a genome database. Among them, A1S_1772 (emrB) and A1S_1773 (emrA) were demonstrated to be co-transcribed as a single operon. Moreover, during osmotic stress, A1S_1772 showed the largest change in gene expression compared to the other emrB-like genes, and deletion of A1S_1772 (AB ΔemrB) significantly slowed cell growth in 20% sucrose. Using a phenotypic microarray analysis, the AB ΔemrB mutant was more susceptible to colistin and nafcillin, paromomycin, spiramycin, and D,L-serine hydroxmate than the wild type. The spot assay, time kill assay and minimal inhibition concentration determination also indicated that the wild type could tolerate colistin better than the AB ΔemrB mutant. Finally, the increased expression levels of all emrB-like genes, including A1S_0775, A1S_0909, A1S_1772, and A1S_1799, in colistin resistance-induced A. baumannii further supported the possible involvement of the emrB genes in A. baumannii colistin resistance. Together, the Emr pump systems in A. baumannii contribute to adaptation to osmotic stress and resistance to colistin.

  16. Development of a real-time PCR assay for the rapid detection of Acinetobacter baumannii from whole blood samples.

    Science.gov (United States)

    De Gregorio, Eliana; Roscetto, Emanuela; Iula, Vita Dora; Martinucci, Marianna; Zarrilli, Raffaele; Di Nocera, Pier Paolo; Catania, Maria Rosaria

    2015-04-01

    Acinetobacter baumannii is a multidrug-resistant pathogen associated with severe infections in hospitalized patients, including pneumonia, urinary and bloodstream infections. Rapid detection of A. baumannii infection is crucial for timely treatment of septicemic patients. The aim of the present study was to develop a specific marker for a quantitative polymerase chain reaction (PCR) assay for the detection of A. baumannii. The target gene chosen is the biofilm-associated protein (bap) gene, encoding a cell surface protein involved in biofilm formation. The assay is specific for A. baumannii, allowing its discrimination from different species of Acinetobacter and other clinically relevant bacterial pathogens. The assay is able to detect one genomic copy of A. baumannii, corresponding to 4 fg of purified DNA, and 20 colony-forming units/ml using DNA extracted from spiked whole blood samples.

  17. Clinical isolates of Acinetobacter baumannii from a Portuguese hospital: PFGE characterization, antibiotic susceptibility and biofilm-forming ability.

    Science.gov (United States)

    Duarte, Andreia; Ferreira, Susana; Almeida, Sofia; Domingues, Fernanda C

    2016-04-01

    Acinetobacter baumannii is an emerging pathogen associated with nosocomial infections that in addition has shown an increasing resistance to antibiotics. In this work the genetic diversity of A. baumannii isolates from a Portuguese hospital, their antibiotic resistance profiles and ability to form biofilms was studied. Seventy-nine clinical A. baumannii isolates were characterized by pulsed-field gel electrophoresis (PFGE) with 9 different PFGE profiles being obtained. Concerning the antimicrobial susceptibility, all A. baumannii isolates were resistant to 12 of the 17 tested antibiotics and classified as multidrug-resistant (MDR). In addition, 74.7% of the isolates showed biofilm formation ability, however no statistical significance with antibiotic resistance was observed. In contrast, urine samples isolates were more likely to form biofilms than strains isolated from other sources. Our findings highlight the high number of MDR A. baumannii isolates and the importance of the formation of biofilms as a potential virulence factor.

  18. The evaluation of staphylococci strains isolated from nasal and bone cultures in patients with chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Mehmet Uluğ

    2012-09-01

    Full Text Available Objectives: In this study, it was aimed to determine theprevalence of nasal carriage of S. aureus in chronic osteomyelitis,assessed trends in methicillin resistance withtime, and evaluated the bone and nasal cultures in staphylococcalchronic osteomyelitis.Materials and methods: Bone and nasal cultures wereperformed intra-operative and pre-operatively from 43patients with chronic osteomyelitis. Inoculation was performedon 5% sheep blood and eosine-methylen-blueagar. The samples were incubated at 37°C for 24 hours.Catalase and coagulase tests were performed on Grampositive coccus strains. Antimicrobial susceptibilities of allS. aureus strains were evaluated by disc diffusion methodaccording to CLSI for oxacillin and other antibiotics.Results: In this study pre-operative nasal cultures andintra-operative bone cultures obtained between May 2005and September 2006 were evaluated retrospectively. Ofthe 43 nasal cultures, 31 (72% yielded staphylococcalstrain, of these 18 (58% were S. aureus. Of the 18 S.aureus strains, 13 (72.2% have methicilline resistance.On the other hand, of the 43 bone cultures, 29 (67.4%yielded staphylococci strain, of these 23 (79.3% were S.aureus. Of the 23 S. aureus strains, 52.1% have methicillineresistance. Overall the similarity rate of staphylococcalstrains was 38% (11/29, while considering the statusof strains resistant to antibiotics; this ratio was 24% (7/29.Conclusions: Nasal S. aureus carriage rate (58% in patientswith chronic osteomyelitis was higher than the communityand the other patient groups. However, the surveillancecultures can give knowledge about the causativepathogen of 25% of the culture negative cases.Key words: Chronic osteomyelitis, nasal carriage, Staphylococcusaureus, bone culture

  19. Surgical management of maxillary and premaxillary osteomyelitis in a reticulated python (Python reticulatus).

    Science.gov (United States)

    Latney, La'Toya V; McDermott, Colin; Scott, Gregory; Soltero-Rivera, Maria M; Beguesse, Kyla; Sánchez, Melissa D; Lewis, John R

    2016-05-01

    CASE DESCRIPTION A 1-year-old reticulated python (Python reticulatus) was evaluated because of a 2-week history of wheezing and hissing. CLINICAL FINDINGS Rostral facial cellulitis and deep gingival pockets associated with missing rostral maxillary teeth were evident. Tissues of the nares were swollen, resulting in an audible wheeze during respiration. Multiple scars and superficial facial wounds attributed to biting by live prey were apparent. Radiographic examination revealed bilateral, focal, rostral maxillary osteomyelitis. TREATMENT AND OUTCOME Wound irrigation, antimicrobials, and anti-inflammatory drug treatment resulted in reduced cellulitis. A 3-week regimen that included empirical antimicrobial treatment and improved husbandry resulted in resolution of the respiratory sounds and partial healing of bite wounds, but radiographic evaluation revealed progressive maxillary osteomyelitis. Microbial culture of blood yielded scant gram-positive cocci and Bacillus spp, which were suspected sample contaminants. Bilateral partial maxillectomies were performed; microbial culture and histologic examination of resected bone confirmed osteomyelitis with gram-positive cocci. Treatment with trimethoprim-sulfamethoxazole was initiated on the basis of microbial susceptibility tests. Four months later, follow-up radiography revealed premaxillary osteomyelitis; surgery was declined, and treatment with trimethoprim-sulfamethoxazole was reinstituted. Eight months after surgery, the patient was reevaluated because of recurrent clinical signs; premaxillectomy was performed, and treatment with trimethoprim-sulfamethoxazole was prescribed on the basis of microbial culture of bone and microbial susceptibility testing. Resolution of osteomyelitis was confirmed by CT 11 months after the initial surgery. CONCLUSIONS AND CLINICAL RELEVANCE Focal maxillectomies and premaxillectomy were successfully performed in a large python. Surgical management and appropriate antimicrobial treatment

  20. Animal models of hematogenous Staphylococcus aureus osteomyelitis in long bones: a review

    Directory of Open Access Journals (Sweden)

    Johansen LK

    2013-08-01

    Full Text Available Louise Kruse Johansen, Henrik Elvang JensenDepartment of Veterinary Disease Biology, Faculty of Health and Medical Science, University of Copenhagen, Frederiksberg, DenmarkAbstract: Hematogenous osteomyelitis (HO, especially due to Staphylococcus aureus, is primarily reported in children and occurs when blood-borne bacteria settle in the metaphysis of a long bone and mediate an inflammatory response. The literature contains several reports on animal models aiming to simulate pediatric HO, in order to investigate the pathogenesis and for therapeutic use. In these models, osteomyelitis lesions develop subsequently to bacteremia, which can be induced by either intravenous or intra-arterial inoculation of bacteria. Intravenous inoculation is not optimal because of the ethical aspects of the extensive systemic reaction and the unpredictable identity of bones being infected. Also, intravenous inoculation often has to be combined with the induction of artificial bone necrosis in order to have macroscopic lesions. In contrast, models based on intra-arterial inoculation and subsequent development of local osteomyelitis, are the most accurate and predictable way to extrapolate to pediatric cases of HO. The most commonly used animal species for modeling of HO are rabbits, chickens, and mice, whereas, less frequently, dogs, rats, and pigs have been applied. The use of intra-arterial inoculation, without simultaneous artificial bone necrosis for the development of HO lesions has only been used in porcine models. Because of the similarity of human and porcine physiology, metabolic rate, and size, porcine models of HO are advantageous. Therefore, porcine models based on the intra-arterial induction of osteomyelitis are the most refined HO models.Keywords: hematogenous osteomyelitis, animal models, Staphylococcus aureus

  1. Alendronate-coated long-circulating liposomes containing 99mtechnetium-ceftizoxime used to identify osteomyelitis.

    Science.gov (United States)

    Ferreira, Diego dos Santos; Boratto, Fernanda Alves; Cardoso, Valbert Nascimento; Serakides, Rogéria; Fernandes, Simone Odília; Ferreira, Lucas Antônio Miranda; Oliveira, Mônica Cristina

    2015-01-01

    Osteomyelitis is a progressive destruction of bones caused by microorganisms. Inadequate or absent treatment increases the risk of bone growth inhibition, fractures, and sepsis. Among the diagnostic techniques, functional images are the most sensitive in detecting osteomyelitis in its early stages. However, these techniques do not have adequate specificity. By contrast, radiolabeled antibiotics could improve selectivity, since they are specifically recognized by the bacteria. The incorporation of these radiopharmaceuticals in drug-delivery systems with high affinity for bones could improve the overall uptake. In this work, long-circulating and alendronate-coated liposomes containing (99m)technetium-radiolabeled ceftizoxime were prepared and their ability to identify infectious foci (osteomyelitis) in animal models was evaluated. The effect of the presence of PEGylated lipids and surface-attached alendronate was evaluated. The bone-targeted long-circulating liposomal (99m)technetium-ceftizoxime showed higher uptake in regions of septic inflammation than did the non-long-circulating and/or alendronate-non-coated liposomes, showing that both the presence of PEGylated lipids and alendronate coating are important to optimize the bone targeting. Scintigraphic images of septic or aseptic inflammation-bearing Wistar rats, as well as healthy rats, were acquired at different time intervals after the intravenous administration of these liposomes. The target-to-non-target ratio proved to be significantly higher in the osteomyelitis-bearing animals for all investigated time intervals. Biodistribution studies were also performed after the intravenous administration of the formulation in osteomyelitis-bearing animals. A significant amount of liposomes were taken up by the organs of the mononuclear phagocyte system (liver and spleen). Intense renal excretion was also observed during the entire experiment period. Moreover, the liposome uptake by the infectious focus was

  2. Apoptosis-associated uncoupling of bone formation and resorption in osteomyelitis

    Science.gov (United States)

    Marriott, Ian

    2013-01-01

    The mechanisms underlying the destruction of bone tissue in osteomyelitis are only now being elucidated. While some of the tissue damage associated with osteomyelitis likely results from the direct actions of bacteria and infiltrating leukocytes, perhaps exacerbated by bacterial manipulation of leukocyte survival pathways, infection-induced bone loss predominantly results from an uncoupling of the activities of osteoblasts and osteoclasts. Bacteria or their products can directly increase osteoclast formation and activity, and the inflammatory milieu at sites of infection can further promote bone resorption. In addition, osteoclast activity is critically regulated by osteoblasts that can respond to bacterial pathogens and foster both inflammation and osteoclastogenesis. Importantly, bone loss during osteomyelitis is also brought about by a decline in new bone deposition due to decreased bone matrix synthesis and by increased rates of osteoblast apoptosis. Extracellular bacterial components may be sufficient to reduce osteoblast viability, but the causative agents of osteomyelitis are also capable of inducing continuous apoptosis of these cells by activating intrinsic and extrinsic cell death pathways to further uncouple bone formation and resorption. Interestingly, bacterial internalization appears to be required for maximal osteoblast apoptosis, and cytosolic inflammasome activation may act in concert with autocrine/paracrine death receptor-ligand signaling to induce cell death. The manipulation of apoptotic pathways in infected bone cells could be an attractive new means to limit inflammatory damage in osteomyelitis. However, the mechanism that is the most important in bacterium-induced bone loss has not yet been identified. Furthermore, it remains to be determined whether the host would be best served by preventing osteoblast cell death or by promoting apoptosis in infected cells. PMID:24392356

  3. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology.

    Science.gov (United States)

    Arias Arias, Carolina; Tamayo Betancur, Maria Carolina; Pinzón, Miguel Alejandro; Cardona Arango, Doris; Capataz Taffur, Cesar Antonio; Correa Prada, Edgar

    2015-01-01

    Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9). Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2), long bones (RR = 1.9; 95% CI 0.5;7.1), fracture (RR = 5.0; 95% CI 0.4;51.4), monotherapy (RR = 3.0; 95% CI 0.6;14.5), receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1), inadequate treatment (RR = 3.1; 95% CI 0.4;20.1), and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2). Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses.

  4. Identification of an Acinetobacter baumannii zinc acquisition system that facilitates resistance to calprotectin-mediated zinc sequestration.

    Directory of Open Access Journals (Sweden)

    M Indriati Hood

    Full Text Available Acinetobacter baumannii is an important nosocomial pathogen that accounts for up to 20 percent of infections in intensive care units worldwide. Furthermore, A. baumannii strains have emerged that are resistant to all available antimicrobials. These facts highlight the dire need for new therapeutic strategies to combat this growing public health threat. Given the critical role for transition metals at the pathogen-host interface, interrogating the role for these metals in A. baumannii physiology and pathogenesis could elucidate novel therapeutic strategies. Toward this end, the role for calprotectin- (CP-mediated chelation of manganese (Mn and zinc (Zn in defense against A. baumannii was investigated. These experiments revealed that CP inhibits A. baumannii growth in vitro through chelation of Mn and Zn. Consistent with these in vitro data, Imaging Mass Spectrometry revealed that CP accompanies neutrophil recruitment to the lung and accumulates at foci of infection in a murine model of A. baumannii pneumonia. CP contributes to host survival and control of bacterial replication in the lung and limits dissemination to secondary sites. Using CP as a probe identified an A. baumannii Zn acquisition system that contributes to Zn uptake, enabling this organism to resist CP-mediated metal chelation, which enhances pathogenesis. Moreover, evidence is provided that Zn uptake across the outer membrane is an energy-dependent process in A. baumannii. Finally, it is shown that Zn limitation reverses carbapenem resistance in multidrug resistant A. baumannii underscoring the clinical relevance of these findings. Taken together, these data establish Zn acquisition systems as viable therapeutic targets to combat multidrug resistant A. baumannii infections.

  5. Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases

    Science.gov (United States)

    2016-01-01

    In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit. PMID:27595089

  6. Through the looking glass; bioactive glass S53P4 (BonAlive®) in the treatment of chronic osteomyelitis.

    LENUS (Irish Health Repository)

    McAndrew, J

    2013-09-01

    In terms of eradication, osteomyelitis represents one of the most challenging infective conditions in medicine and surgery. In recent years, the use of bioactive glass in conjunction with antimicrobial therapy has emerged as a viable new treatment.

  7. Unusual bone-scan findings in acute osteomyelitis: case report. [/sup 99m/Tc tracer technique

    Energy Technology Data Exchange (ETDEWEB)

    Russin, L.D.; Staab, E.V.

    1976-07-01

    In osteomyelitis, bone-scan findings precede the appearance of bone changes on radiographs. In cases where focal ischemia occurs, the earliest scan finding may be a cold area that later becomes hot as active periostitis develops.

  8. Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases.

    Science.gov (United States)

    Park, Joonhyoung; Myoung, Hoon

    2016-08-01

    In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.

  9. Bone infection in patients suspected of complicating osteomyelitis: the diagnostic value of dual isotope bone-granulocyte scintigraphy

    DEFF Research Database (Denmark)

    Buhl, Thora; Stentzer, Kim; Hede, Adam;

    2005-01-01

    AIM: The purpose of this study was to evaluate the diagnostic value of dual isotope bone-granulocyte scintigraphy in patients with known bone pathology clinically suspected of osteomyelitis, i.e. complicating osteomyelitis, using per-operative bacterial culture from bone as reference. METHODS...... interpreted as positive for osteomyelitis if regions of interests of pathologic 111In granulocyte accumulation included 99mTc MDP activity on the bone images (except in the spine). RESULTS: The sensitivity, specificity, and accuracy were 84, 71 and 79%, respectively, for simultaneous, dual isotope bone......-granulocyte scintigraphy, higher than the other diagnostic parameters. CONCLUSION: Simultaneous bone-granulocyte scintigraphy is a valuable diagnostic tool in diagnosing osteomyelitis complicating other bone pathology with or without soft-tissue infection....

  10. Clinical Management of Suppurative Osteomyelitis, Bisphosphonate-Related Osteonecrosis, and Osteoradionecrosis: Report of Three Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Eduardo Pereira Guimarães

    2013-01-01

    Full Text Available In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN and bisphosphonate-related osteonecrosis of the jaws (BRONJ. Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.

  11. Synergistic activity of coriander oil and conventional antibiotics against Acinetobacter baumannii.

    Science.gov (United States)

    Duarte, A; Ferreira, S; Silva, F; Domingues, F C

    2012-02-15

    In this study we investigated the existence of synergistic antibacterial effect between coriander (Coriandrum sativum L.) essential oil and six different antibacterial drugs (cefoperazone, chloramphenicol, ciprofloxacin, gentamicin, tetracycline and piperacillin). The antibacterial activity of coriander oil was assessed using microdilution susceptibility testing and synergistic interaction by checkerboard assays. The association of coriander essential oil with chloramphenicol, ciprofloxacin, gentamicin and tetracycline against Acinetobacter baumannii showed in vitro effectiveness, which is an indicator of a possible synergistic interaction against two reference strains of A. baumannii (LMG 1025 and LMG 1041) (FIC index from 0.047 to 0.375). However, when tested the involvement between coriander essential oil and piperacillin or cefoperazone, the isobolograms and FIC index showed an additive interaction. The in vitro interaction could improve the antimicrobial effectiveness of ciprofloxacin, gentamicin and tetracycline and may contribute to resensitize A. baumannii to the action of chloramphenicol.

  12. Genomic Island Location in Acinetobacter baumannii Strains by tRIP-PCR Technique

    Directory of Open Access Journals (Sweden)

    Suhadsaad

    2013-11-01

    Full Text Available This study was performed to detect the presence of genomic islands which usually insert in the tRNA genes and other non-coding RNA genes, in this study eight strains of Acinetobacter baumannii (AYE, A457, A14, A424 A473, A92, ACICU, A25 were tested by used of tRIP-(tRNA site Interrogation for Pathogeni city islands, prophases and other GIs-PCR method. The results of PCR and agarose gel electrophoresis for eight strains of two loci #7, #24 were: the results of #7 loci screening showed that all strains were positive except A. baumannii 457 strain was negative. While the results of #24 loci showed presence of foreign DNA in A. baumannii AYE, A457, A14, A424, A473, A92 except the results of (ACICU, A25 was positive.

  13. Early dissemination of OXA-72-producing Acinetobacter baumannii strain in Colombia: a case report.

    Science.gov (United States)

    Saavedra, Sandra Yamile; Cayô, Rodrigo; Gales, Ana Cristina; Leal, Aura Lucia; Saavedra, Carlos Humberto

    2014-01-01

    Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii isolates have reached epidemic levels in past decades. Currently this microorganism is responsible for outbreaks of difficult eradication and with high mortality rates worldwide. We herein report a rare case of an OXA-72-producing A. baumannii isolate colonizing a 47-year-old male patient with peritonitis due to abdominal stab wound, four years earlier than the first report of this carbapenemase in Acinetobacter pittii in Colombia. Although OXA-72 presents a low prevalence compared with OXA-23, our study demonstrated that A. baumannii isolates carrying the blaOXA-72 gene were present in the hospital environment in Colombia and could act as a reservoir for further spread to other Acinetobacter species, like A. pittii, causing carbapenem-resistance.

  14. A multi-resistant Acinetobacter baumannii outbreak in a general intensive care unit.

    Science.gov (United States)

    Levidiotou, Stamatina; Galanakis, Emmanouil; Vrioni, Georgia; Papamichael, Dimitrios; Nakos, Georgios; Stefanou, Dimitrios

    2002-01-01

    In an Intensive Care Unit, three patients were found infected and two colonized with multiresistant Acinetobacter baumannii within a period of one week. To identify the outbreak source, two surveillance studies were performed concerning patients and the environment. Genotyping of isolates was performed by random amplification of polymorphic DNA analysis (RAPD). Environmental sampling failed to yield A. baumannii, with the exception of a single sample from a trunking. RAPD-fingerprinting yielded identical patterns for all patient isolates including the trunking isolate, thus confirming the suspected cluster. Since the strain from the trunking had a susceptibility pattern and a RAPD pattern identical to that of the strains isolated from the patients, we believe that this was the likely source of the outbreak. In conclusion, A. baumannii outbreaks may be quickly controlled by appropriate action of the hospital infection staff. RAPD-fingerprinting may provide a useful and rapid identification technique for the epidemiological investigation of a hospital outbreak.

  15. Outbreak of resistant Acinetobacter baumannii- measures and proposal for prevention and control.

    Science.gov (United States)

    Romanelli, Roberta Maia de Castro; Jesus, Lenize Adriana de; Clemente, Wanessa Trindade; Lima, Stella Sala Soares; Rezende, Edna Maria; Coutinho, Rosane Luiza; Moreira, Ricardo Luiz Fontes; Neves, Francelli Aparecida Cordeiro; Brás, Nelma de Jesus

    2009-10-01

    Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

  16. Systematic Review of Antimicrobial Resistance of Clinical Acinetobacter baumannii Isolates in Iran: An Update.

    Science.gov (United States)

    Razavi Nikoo, Hadi; Ardebili, Abdollah; Mardaneh, Jalal

    2017-01-13

    Treatment of Acinetobacter baumannii has become a medical challenge because of the increasing incidence of multiresistant strains and a lack of viable treatment alternatives. This systematic review attempts to investigate the changes in resistance of A. baumannii to different classes of antibiotics in Iran, with emphasis on the antimicrobial activity of polymyxin B (PMB) and colistin (COL). Biomedical databases were searched for English-published articles evaluating microbiological activity of various antimicrobial agents, including PMB and COL. Then, the available data were extracted and analyzed. Thirty-one studies, published from 2009 to 2015, were identified which contain data for 3,018 A. baumannii clinical isolates. With the exception of polymyxins and tigecycline (TIG), there was a high rate of resistance to various groups of antibiotics, including carbapenems. The minimum inhibitory concentration (MIC) ranges for PMB and COL on A. baumannii isolates tested were 0.12-64 μg/ml and 0.001-128 μg/ml, respectively. Polymyxins showed adequate activity with no significant trends in the resistance rate during most of the study period. The incidence of resistance to TIG was estimated low from 2% to 38.4% among the majority of A. baumannii. The present systematic review of the published literatures revealed that multidrug-resistant (including carbapenem-resistant) strains of A. baumannii have increased in Iran. In these circumstances, the older antibiotics, such as COL or PMB, preferably in combination with other antimicrobials (rifampicin, meropenem), could be considered as the therapeutic solution against the healthcare-associated infections. Designing rational dosage regimens for patients to maximize the antimicrobial activity and minimize the emergence and prevalence of resistance is recommended.

  17. Mortality associated with Acinetobacter baumannii infections experienced by lung transplant recipients.

    Science.gov (United States)

    Nunley, D R; Bauldoff, G S; Mangino, J E; Pope-Harman, A L

    2010-10-01

    Lung transplantation (LTX) requires continual systemic immunosuppression, which can result in infections that may compromise recipient survival. A recent outbreak of Acinetobacter baumannii at our institution resulted in infections experienced in both LTX recipients and nontransplant patients. A retrospective review was conducted of patients who had A. baumannii recovered from blood, other normally sterile body fluids, and/or respiratory secretions and who had clinical follow-up extending to 1 year postinfection. A. baumannii was considered "multidrug-resistant" when its growth was not inhibited by minimum inhibitory concentrations of multiple antibiotics. Despite the resistance profile, patients were treated with a combination of antibiotics, which included tigecycline, colistimethate, and when susceptible, imipenem. Once infection was diagnosed, immunosuppression was reduced in all LTX recipients. Six LTX recipients became infected with A. baumannii and were contrasted to infections identified in 14 non-LTX, nonimmunosuppressed patients. A. baumannii was persistently recovered in 4 of 6 LTX recipients (66.7%) compared with only 1 of 14 (7.1%) non-LTX patients (χ(2) = 9.9, p = 0.005). LTX recipients received antibiotic therapy for an average of 76 ± 18.4 days compared with 16.0 ± 6.8 days for the non-LTX patients (p = 0.025, Mann-Whitney U test). All 4 of the 6 (66.7%) LTX recipients died as a consequence of their infection compared with 1 of 14 (7.1%) of the non-LTX patients (χ(2) = 9.9, p = 0.005). Despite receiving more antibiotic therapy, LTX recipients who were infected with multidrug-resistant A. baumannii were less likely to clear their infection and experienced greater mortality compared with non-LTX patients.

  18. Iron-Regulated Phospholipase C Activity Contributes to the Cytolytic Activity and Virulence of Acinetobacter baumannii

    Science.gov (United States)

    Fiester, Steven E.; Schmidt, Robert E.; Beckett, Amber C.; Ticak, Tomislav; Carrier, Mary V.; Ghosh, Rajarshi; Ohneck, Emily J.; Metz, Maeva L.; Sellin Jeffries, Marlo K.; Actis, Luis A.

    2016-01-01

    Acinetobacter baumannii is an opportunistic Gram-negative pathogen that causes a wide range of infections including pneumonia, septicemia, necrotizing fasciitis and severe wound and urinary tract infections. Analysis of A. baumannii representative strains grown in Chelex 100-treated medium for hemolytic activity demonstrated that this pathogen is increasingly hemolytic to sheep, human and horse erythrocytes, which interestingly contain increasing amounts of phosphatidylcholine in their membranes. Bioinformatic, genetic and functional analyses of 19 A. baumannii isolates showed that the genomes of each strain contained two phosphatidylcholine-specific phospholipase C (PC-PLC) genes, which were named plc1 and plc2. Accordingly, all of these strains were significantly hemolytic to horse erythrocytes and their culture supernatants tested positive for PC-PLC activity. Further analyses showed that the transcriptional expression of plc1 and plc2 and the production of phospholipase and thus hemolytic activity increased when bacteria were cultured under iron-chelation as compared to iron-rich conditions. Testing of the A. baumannii ATCC 19606T plc1::aph-FRT and plc2::aph isogenic insertion derivatives showed that these mutants had a significantly reduced PC-PLC activity as compared to the parental strain, while testing of plc1::ermAM/plc2::aph demonstrated that this double PC-PLC isogenic mutant expressed significantly reduced cytolytic and hemolytic activity. Interestingly, only plc1 was shown to contribute significantly to A. baumannii virulence using the Galleria mellonella infection model. Taken together, our data demonstrate that both PLC1 and PLC2, which have diverged from a common ancestor, play a concerted role in hemolytic and cytolytic activities; although PLC1 seems to play a more critical role in the virulence of A. baumannii when tested in an invertebrate model. These activities would provide access to intracellular iron stores this pathogen could use during

  19. Effects of silver nanoparticles in combination with antibiotics on the resistant bacteria Acinetobacter baumannii

    Directory of Open Access Journals (Sweden)

    Wan G

    2016-08-01

    Full Text Available Guoqing Wan,1,2 Lingao Ruan,2,3 Yu Yin,2,3 Tian Yang,2,3 Mei Ge,2 Xiaodong Cheng1,4 1School of Life Science and Technology, China Pharmaceutical University, Nanjing, 2Shanghai Laiyi Center for Biopharmaceutical R&D, 3School of Pharmacy, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4Department of Integrative Biology & Pharmacology, The University of Texas Health Science Center, Houston, TX, USA Abstract: Acinetobacter baumannii resistance to carbapenem antibiotics is a serious clinical challenge. As a newly developed technology, silver nanoparticles (AgNPs show some excellent characteristics compared to older treatments, and are a candidate for combating A. baumannii infection. However, its mechanism of action remains unclear. In this study, we combined AgNPs with antibiotics to treat carbapenem-resistant A. baumannii (aba1604. Our results showed that single AgNPs completely inhibited A. baumannii growth at 2.5 µg/mL. AgNP treatment also showed synergistic effects with the antibiotics polymixin B and rifampicin, and an additive effect with tigecyline. In vivo, we found that AgNPs–antibiotic combinations led to better survival ratios in A. baumannii-infected mouse peritonitis models than that by single drug treatment. Finally, we employed different antisense RNA-targeted Escherichia coli strains to elucidate the synergistic mechanism involved in bacterial responses to AgNPs and antibiotics. Keywords: Acinetobacter baumannii, AgNPs, synergistic, antibiotic combination, anti­sense RNA 

  20. Repurposing the anticancer drug mitomycin C for the treatment of persistent Acinetobacter baumannii infections.

    Science.gov (United States)

    Cruz-Muñiz, Martha Yumiko; López-Jacome, Luis Esau; Hernández-Durán, Melissa; Franco-Cendejas, Rafael; Licona-Limón, Paula; Ramos-Balderas, Jose Luis; Martinéz-Vázquez, Mariano; Belmont-Díaz, Javier A; Wood, Thomas K; García-Contreras, Rodolfo

    2017-01-01

    Acinetobacter baumannii is an emergent opportunistic bacterial pathogen responsible for recalcitrant infections owing to its high intrinsic tolerance to most antibiotics; therefore, suitable strategies to treat these infections are needed. One plausible approach is the repurposing of drugs that are already in use. Among them, anticancer drugs may be especially useful due their cytotoxic activities and ample similarities between bacterial infections and growing tumours. In this work, the effectiveness of four anticancer drugs on the growth of A. baumannii ATTC BAA-747 was evaluated, including the antimetabolite 5-fluorouracil and three DNA crosslinkers, namely cisplatin, mitomycin C (MMC) and merphalan. MMC was the most effective drug, having a minimum inhibitory concentration for 50% of growth in Luria-Bertani medium at ca. 7 µg/mL and completely inhibiting growth at 25 µg/mL. Hence, MMC was tested against a panel of 21 clinical isolates, including 18 multidrug-resistant (MDR) isolates, 3 of which were sensitive only to colistin. The minimum inhibitory concentrations and minimum bactericidal concentrations of MMC in all tested strains were found to be similar to those of A. baumannii ATCC BAA-747, and MMC also effectively killed stationary-phase, persister and biofilm cells. Moreover, MMC was able to increase survival of the insect larvae Galleria mellonella against an otherwise lethal A. baumannii infection from 0% to ≥53% for the antibiotic-sensitive A. baumannii ATCC BAA-747 strain and the MDR strains A560 and A578. Therefore, MMC is highly effective at killing the emergent opportunistic pathogen A. baumannii.

  1. Repeated local emergence of carbapenem-resistant Acinetobacter baumannii in a single hospital ward

    Science.gov (United States)

    Pham Thanh, Duy; Tran Do Hoan, Nhu; Wick, Ryan R.; Ingle, Danielle J.; Hawkey, Jane; Edwards, David J.; Kenyon, Johanna J.; Phu Huong Lan, Nguyen; Campbell, James I.; Thwaites, Guy; Thi Khanh Nhu, Nguyen; Hall, Ruth M.; Fournier-Level, Alexandre; Baker, Stephen; Holt, Kathryn E.

    2016-01-01

    We recently reported a dramatic increase in the prevalence of carbapenem-resistant Acinetobacter baumannii infections in the intensive care unit (ICU) of a Vietnamese hospital. This upsurge was associated with a specific oxa23-positive clone that was identified by multilocus VNTR analysis. Here, we used whole-genome sequence analysis to dissect the emergence of carbapenem-resistant A. baumannii causing ventilator-associated pneumonia (VAP) in the ICU during 2009–2012. To provide historical context and distinguish microevolution from strain introduction, we compared these genomes with those of A. baumannii asymptomatic carriage and VAP isolates from this same ICU collected during 2003–2007. We identified diverse lineages co-circulating over many years. Carbapenem resistance was associated with the presence of oxa23, oxa40, oxa58 and ndm1 genes in multiple lineages. The majority of resistant isolates were oxa23-positive global clone GC2; fine-scale phylogenomic analysis revealed five distinct GC2 sublineages within the ICU that had evolved locally via independent chromosomal insertions of oxa23 transposons. The increase in infections caused by carbapenem-resistant A. baumannii was associated with transposon-mediated transmission of a carbapenemase gene, rather than clonal expansion or spread of a carbapenemase-harbouring plasmid. Additionally, we found evidence of homologous recombination creating diversity within the local GC2 population, including several events resulting in replacement of the capsule locus. We identified likely donors of the imported capsule locus sequences amongst the A. baumannii isolated on the same ward, suggesting that diversification was largely facilitated via reassortment and sharing of genetic material within the localized A. baumannii population.

  2. Predictors of mortality in patients with extensively drug-resistant Acinetobacter baumannii pneumonia receiving colistin therapy.

    Science.gov (United States)

    Choi, Ik Sung; Lee, Yu Ji; Wi, Yu Mi; Kwan, Byung Soo; Jung, Kae Hwa; Hong, Woong Pyo; Kim, June Myong

    2016-08-01

    The ratio of the area under the free (unbound) concentration-time curve to minimum inhibitory concentration (fAUC/MIC) was proposed to be the pharmacokinetic/pharmacodynamic index most strongly linked to the antibacterial effect of colistin against Acinetobacter baumannii. A retrospective study of patients who received colistin to treat pneumonia caused by extensively drug-resistant (XDR) A. baumannii over a 4-year period was performed to assess the impact of the colistin MIC on mortality. A total of 227 patients were included in the analysis. The 7-day and 14-day mortality rates of patients with XDR A. baumannii pneumonia receiving colistin therapy were 15.0% and 23.8%, respectively. In the multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, days from index culture to first dose of colistin, underlying tumour and septic shock at presentation were independent predictors of mortality in patients with XDR A. baumannii pneumonia receiving colistin therapy. In the univariate analysis, the colistin dose based on ideal body weight (IBW) correlated with patient outcome. Therefore, the use of IBW appeared to be more appropriate to calculate the colistin dosage. In addition, these results highlight the clinical significance of colistin MIC in patients with XDR A. baumannii pneumonia receiving colistin therapy. Although MICs were in the 'susceptible' range, patients infected with isolates with high colistin MICs showed a poorer clinical response rate than patients infected with isolates with low colistin MICs. Further clinical studies are needed to evaluate the roles of colistin MIC for predicting mortality in XDR A. baumannii pneumonia with a high colistin MIC.

  3. Clinical epidemiology and resistance mechanisms of carbapenem-resistant Acinetobacter baumannii, French Guiana, 2008-2014.

    Science.gov (United States)

    Mahamat, Aba; Bertrand, Xavier; Moreau, Brigitte; Hommel, Didier; Couppie, Pierre; Simonnet, Christine; Kallel, Hatem; Demar, Magalie; Djossou, Felix; Nacher, Mathieu

    2016-07-01

    This study investigated the clinical epidemiology and resistance mechanisms of Acinetobacter baumannii and characterised the clonal diversity of carbapenem-resistant A. baumannii (CRAB) during an ICU-associated outbreak at Cayenne Hospital, French Guiana. All non-duplicate A. baumannii isolates from 2008 to 2014 were tested for antibiotic susceptibility by disk diffusion. Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on CRAB. Of the 441 A. baumannii isolates, most were from males (54.0%) and were detected mainly from the ICU (30.8%) and medicine wards (21.8%). In the ICU, strains were mainly isolated from the respiratory tract (44.1%) and bloodstream (14.0%), whereas in medicine wards they mainly were from wound/drainage (36.5%) and bloodstream (25.0%). A. baumannii showed the greatest susceptibility to piperacillin/tazobactam (92.7%), imipenem (92.5%), colistin (95.6%) and amikacin (97.2%), being lower in the ICU and medicine wards compared with other wards. An outbreak of OXA-23-producing CRAB occurred in the 13-bed ICU in 2010. CRAB strains were more co-resistant to other antimicrobials compared with non-CRAB. Molecular genetics analysis revealed five sequence types [ST78, ST107 and ST642 and two new STs (ST830 and ST831)]. Analysis of PFGE profiles indicated cross-transmissions of CRAB within the ICU, between the ICU and one medicine ward during transfer of patients, and within that medicine ward. This study provides the first clinical and molecular data of A. baumannii from French Guiana and the Amazon basin. The ICU was the highest risk unit of this nosocomial outbreak of OXA-23-producing CRAB, which could subsequently disseminate within the hospital.

  4. Structural and bioinformatic characterization of an Acinetobacter baumannii type II carrier protein

    Energy Technology Data Exchange (ETDEWEB)

    Allen, C. Leigh; Gulick, Andrew M., E-mail: gulick@hwi.buffalo.edu [University at Buffalo, Buffalo, NY 14203 (United States)

    2014-06-01

    The high-resolution crystal structure of a free-standing carrier protein from Acinetobacter baumannii that belongs to a larger NRPS-containing operon, encoded by the ABBFA-003406–ABBFA-003399 genes of A. baumannii strain AB307-0294, that has been implicated in A. baumannii motility, quorum sensing and biofilm formation, is presented. Microorganisms produce a variety of natural products via secondary metabolic biosynthetic pathways. Two of these types of synthetic systems, the nonribosomal peptide synthetases (NRPSs) and polyketide synthases (PKSs), use large modular enzymes containing multiple catalytic domains in a single protein. These multidomain enzymes use an integrated carrier protein domain to transport the growing, covalently bound natural product to the neighboring catalytic domains for each step in the synthesis. Interestingly, some PKS and NRPS clusters contain free-standing domains that interact intermolecularly with other proteins. Being expressed outside the architecture of a multi-domain protein, these so-called type II proteins present challenges to understand the precise role they play. Additional structures of individual and multi-domain components of the NRPS enzymes will therefore provide a better understanding of the features that govern the domain interactions in these interesting enzyme systems. The high-resolution crystal structure of a free-standing carrier protein from Acinetobacter baumannii that belongs to a larger NRPS-containing operon, encoded by the ABBFA-003406–ABBFA-003399 genes of A. baumannii strain AB307-0294, that has been implicated in A. baumannii motility, quorum sensing and biofilm formation, is presented here. Comparison with the closest structural homologs of other carrier proteins identifies the requirements for a conserved glycine residue and additional important sequence and structural requirements within the regions that interact with partner proteins.

  5. Diversity of multi-drug resistant Acinetobacter baumannii population in a major hospital in Kuwait

    Directory of Open Access Journals (Sweden)

    Leila eVali

    2015-07-01

    Full Text Available Acinetobacter baumannii is one of the most important opportunistic pathogens that causes serious health care associated complications in critically ill patients. In the current study we report on the diversity of the clinical multi-drug resistant A. baumannii in Kuwait by molecular characterization. One hundred A. baumannii were isolated from one of the largest governmental hospitals in Kuwait. Following the identification of the isolates by molecular methods, the amplified blaOXA-51-like gene product of one isolate (KO-12 recovered from blood showed the insertion of the ISAba19 at position 379 in blaOXA-78. Of the 33 multi-drug resistant isolates, 28 (85% contained blaOXA-23, 2 (6% blaOXA-24 and 6 (18% blaPER-1 gene. We did not detect blaOXA-58, blaVIM, blaIMP, blaGES, blaVEB and blaNDM genes in any of the tested isolates. In 3 blaPER-1 positive isolates the genetic environment of blaPER-1 consisted of two copies of ISPa12 (tnpiA1 surrounding the blaPER-1 gene on a highly stable plasmid of ca. 140-kb. MLST analysis of the 33 A. baumannii isolates identified 20 different STs, of which 6 (ST-607, ST-608, ST-609, ST-610, ST-611 and ST-612 were novel. Emerging STs such as ST15 (identified for the first time in the Middle East, ST78 and ST25 were also detected. The predominant clonal complex was CC2. PFGE and MLST defined the MDR isolates as multi-clonal with diverse lineages. Our results lead us to believe that A. baumannii is diverse in clonal origins and / or is undergoing clonal expansion continuously while multiple lineages of MDR A. baumannii circulate in hospital wards simultaneously.

  6. Outbreak of resistant Acinetobacter baumannii: measures and proposal for prevention and control

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    Roberta Maia de Castro Romanelli

    2009-10-01

    Full Text Available Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

  7. Epidemiologic and clinical impact of Acinetobacter baumannii colonization and infection: a reappraisal.

    Science.gov (United States)

    Villar, Macarena; Cano, María E; Gato, Eva; Garnacho-Montero, José; Miguel Cisneros, José; Ruíz de Alegría, Carlos; Fernández-Cuenca, Felipe; Martínez-Martínez, Luis; Vila, Jordi; Pascual, Alvaro; Tomás, María; Bou, Germán; Rodríguez-Baño, Jesús

    2014-07-01

    Acinetobacter baumannii is one of the most important antibiotic-resistant nosocomial bacteria. We investigated changes in the clinical and molecular epidemiology of A. baumannii over a 10-year period. We compared the data from 2 prospective multicenter cohort studies in Spain, one performed in 2000 (183 patients) and one in 2010 (246 patients), which included consecutive patients infected or colonized by A. baumannii. Molecular typing was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). The incidence density of A. baumannii colonization or infection increased significantly from 0.14 in 2000 to 0.52 in 2010 in medical services (p infections were carbapenems in 2000 (45%) and colistin in 2010 (50.3%). There was molecular-typing evidence of an increase in the frequency of A. baumannii acquisition in non-intensive care unit wards in 2010 (7.6% in 2000 vs 19.2% in 2010, p = 0.01). By MSLT, the ST2 clonal group predominated and increased in 2010. This epidemic clonal group was more frequently resistant to imipenem and was associated with an increased risk of sepsis, although not with severe sepsis or mortality. Some significant changes were noted in the epidemiology of A. baumannii, which is increasingly affecting patients admitted to conventional wards and is also the cause of non-nosocomial health care-associated infections. Epidemic clones seem to combine antimicrobial resistance and the ability to spread, while maintaining their clinical virulence.

  8. Deciphering the iron response in Acinetobacter baumannii: A proteomics approach.

    Science.gov (United States)

    Nwugo, Chika C; Gaddy, Jennifer A; Zimbler, Daniel L; Actis, Luis A

    2011-01-01

    Iron is an essential nutrient that plays a role in bacterial differential gene expression and protein production. Accordingly, the comparative analysis of total lysate and outer membrane fractions isolated from A. baumannii ATCC 19606(T) cells cultured under iron-rich and -chelated conditions using 2-D gel electrophoresis-mass spectrometry resulted in the identification of 58 protein spots differentially produced. While 19 and 35 of them represent iron-repressed and iron-induced protein spots, respectively, four other spots represent a metal chelation response unrelated to iron. Most of the iron-repressed protein spots represent outer membrane siderophore receptors, some of which could be involved in the utilization of siderophores produced by other bacteria. The iron-induced protein spots represent a wide range of proteins including those involved in iron storage, such as Bfr, metabolic and energy processes, such as AcnA, AcnB, GlyA, SdhA, and SodB, as well as lipid biosynthesis. The detection of an iron-regulated Hfq ortholog indicates that iron regulation in this bacterium could be mediated by Fur and small RNAs as described in other bacteria. The iron-induced production of OmpA suggests this protein plays a role in iron metabolism as shown by the diminished ability of an isogenic OmpA deficient derivative to grow under iron-chelated conditions.

  9. Evidence for HLA class II susceptible and protective haplotypes for osteomyelitis in pediatric patients with sickle cell anemia.

    Science.gov (United States)

    Al-Ola, K; Mahdi, N; Al-Subaie, A M; Ali, M E; Al-Absi, I K; Almawi, W Y

    2008-05-01

    We investigated the association of human leukocyte antigen (HLA) class II alleles and haplotypes with the pathogenesis of sickle cell anemia (SCA) osteomyelitis. SCA patients comprised 42 patients with osteomyelitis and 150 patients without osteomyelitis; HLA-DRB1* and HLA-DQB1* genotyping was performed by polymerase chain reaction-sequence-specific priming (SSP). DRB1*100101 (P value corrected for the number of different alleles tested, Pc=0.003) was positively associated with osteomyelitis. At the haplotype level, DRB1*100101-DQB1*050101 (Pc=0.001) was more prevalent among patients, while DRB1*030101-DQB1*0201 (Pc=0.020) and DRB1*040101-DQB1*0302 (Pc=0.039) were more prevalent among SCA controls, thereby conferring disease susceptibility or protection to these haplotypes, respectively. These results show that specific HLA haplotypes influence SCA osteomyelitis risk and that specific HLA types may serve as markers for identifying SCA patients at high risk for osteomyelitis.

  10. Adjuvant role of Pseudomonas flagellin for Acinetobacter baumannii biofilm associated protein

    Science.gov (United States)

    Sefidi, Mozhgan Derakhshan; Rasooli, Iraj; Owlia, Parviz; Talei, Daryush; Astaneh, Shakiba Darvish Alipour; Nazarian, Shahram

    2016-01-01

    AIM To study immunogenicity of Pseudomonas N terminal flagellin as an adjuvant for Acinetobacter baumannii (A. baumannii) biofilm associated protein (Bap). METHODS The N terminal flagellin gene was amplified. The pET28a (+) and polymerase chain reaction products were digested with HindIII and EcoR I. The ligation of N terminal flagellin into pET28a (‏+) was performed using T4 DNA ligase and was then transformed into Escherichia coli BL21 (DE3) as a suitable expression host. pET28a (‏+) vector harboring a conserved region of Bap from our previous work was used. The recombinant proteins were expressed, analyzed by SDS-PAGE method and was purified by affinity chromatography with His-Tag residues followed by confirmation with western blotting. Mice were immunized with recombinant N terminal flagellin and Bap subunits. The immunized animals were intranasally (i.n) challenged with A. baumannii and Pseudomonas aeruginosa (P. aeruginosa). RESULTS The flagellin enhanced the immunogenicity of Bap causing an increase in specific IgG titers in serum (P Bap-Flagellin immunized group challenged with A. baumannii showed significantly lower bacterial load compared to the control group. The bacterial loads were studied in internal organs. A. baumannii infected immunized animals with Bap-Flagellin exhibited internal organs with minor bacterial load while P. aeruginosa PAO1 infected group showed heavy bacterial load of (4.3 ± 0.12) × 106, (1.1 ± 0.01) × 106 and (2.2 ± 0.22) × 106 per gram of lungs, liver and spleen respectively. Bacterial loads were detected per gram of lungs, liver and spleen of the mice group immunized with Bap were (1.2 ± 0.06) × 107, (11.1 ± 0.041) × 105 and (3.6 ± 0.42) × 106 respectively. In vivo neutralization assay indicated that all experimental mice groups, except for Flagellin administered group was significantly (P < 0.05) protected against A. baumannii. CONCLUSION These results demonstrate that P. aeruginosa Flagellin as an adjuvant for

  11. Neglected Fournier's Gangrene Caused by Acinetobacter baumannii: A Rare Case Report

    Science.gov (United States)

    Emre, Arif; Sertkaya, Mehmet; Duman, Yakup; Kale, Ilhami Taner

    2016-01-01

    Fournier's gangrene, rare but life threatening disease, is characterized by an acute necrotic infection of the scrotum, penis, or perineum. Fournier's gangrene is a mixed infection caused by both aerobic and anaerobic bacteria. Fournier's gangrene caused by multidrug resistant Acinetobacter baumannii have been reported rarely. The mainstay of treatment is prompt recognition and a combination of antibiotics with radical debridement. We describe a case of a 56-year-old male patient presenting with neglected Fournier's gangrene caused by Acinetobacter baumannii. Many treatment modalities including broad-spectrum antibiotics, aggressive debridement, negative pressure wound therapy, diversion colostomy, and partial-thickness skin grafts were applied to save the patient's life. PMID:27725892

  12. The effect of terminal cleaning on environmental contamination rates of multidrug-resistant Acinetobacter baumannii.

    Science.gov (United States)

    Strassle, Paula; Thom, Kerri A; Johnson, J Kristie; Johnsonm, J Kristie; Leekha, Surbhi; Lissauer, Matthew; Zhu, Jingkun; Harris, Anthony D

    2012-12-01

    We evaluated the prevalence of multidrug-resistant Acinetobacter baumannii environmental contamination before and after discharge cleaning in rooms of infected/colonized patients. 46.9% of rooms and 15.3% of sites were found contaminated precleaning, and 25% of rooms and 5.5% of sites were found contaminated postcleaning. Cleaning significantly decreased environmental contamination of A baumannii; however, persistent contamination represents a significant risk factor for transmission. Further studies on this and more effective cleaning methods are needed.

  13. Diagnosing Diabetic Foot Osteomyelitis in Patients Without Signs of Soft Tissue Infection by Coupling Hybrid 67Ga SPECT/CT With Bedside Percutaneous Bone Puncture

    OpenAIRE

    Aslangul, Elisabeth; M’Bemba, Jocelyne; Caillat-Vigneron, Nadine; Coignard, Sophie; Larger, Etienne; Boitard, Christian; Lipsky, Benjamin A.

    2013-01-01

    OBJECTIVE Successful treatment of osteomyelitis is more likely with accurate diagnosis and identification of the causative pathogens. This typically requires obtaining a specimen of bone, usually by image-guided biopsy. We sought to develop a simpler bedside method for definitively diagnosing osteomyelitis. RESEARCH DESIGN AND METHODS Over 2 years, we enrolled consecutive patients presenting to our diabetic foot clinic with a foot ulcer and clinically suspected osteomyelitis but without soft ...

  14. Gentamicin coating of plasma chemical oxidized titanium alloy prevents implant-related osteomyelitis in rats.

    Science.gov (United States)

    Diefenbeck, M; Schrader, C; Gras, F; Mückley, T; Schmidt, J; Zankovych, S; Bossert, J; Jandt, K D; Völpel, A; Sigusch, B W; Schubert, H; Bischoff, S; Pfister, W; Edel, B; Faucon, M; Finger, U

    2016-09-01

    Implant related infection is one of the most feared and devastating complication associated with the use of orthopaedic implant devices. Development of anti-infective surfaces is the main strategy to prevent implant contamination, biofilm formation and implant related osteomyelitis. A second concern in orthopaedics is insufficient osseointegration of uncemented implant devices. Recently, we reported on a macroporous titanium-oxide surface (bioactive TiOB) which increases osseointegration and implant fixation. To combine enhanced osseointegration and antibacterial function, the TiOB surfaces were, in addition, modified with a gentamicin coating. A rat osteomyelitis model with bilateral placement of titanium alloy implants was employed to analyse the prophylactic effect of gentamicin-sodiumdodecylsulfate (SDS) and gentamicin-tannic acid coatings in vivo. 20 rats were randomly assigned to four groups: (A) titanium alloy; PBS inoculum (negative control), (B) titanium alloy, Staphylococcus aureus inoculum (positive control), (C) bioactive TiOB with gentamicin-SDS and (D) bioactive TiOB plus gentamicin-tannic acid coating. Contamination of implants, bacterial load of bone powder and radiographic as well as histological signs of implant-related osteomyelitis were evaluated after four weeks. Gentamicin-SDS coating prevented implant contamination in 10 of 10 tibiae and gentamicin-tannic acid coating in 9 of 10 tibiae (infection prophylaxis rate 100% and 90% of cases, respectively). In Group (D) one implant showed colonisation of bacteria (swab of entry point and roll-out test positive for S. aureus). The interobserver reliability showed no difference in the histologic and radiographic osteomyelitis scores. In both gentamicin coated groups, a significant reduction of the histological osteomyelitis score (geometric mean values: C = 0.111 ± 0.023; D = 0.056 ± 0.006) compared to the positive control group (B: 0.244 ± 0.015; p < 0.05) was observed. The

  15. Emergence of Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Clinical Isolates Collected from Some Libyan Hospitals.

    Science.gov (United States)

    Mathlouthi, Najla; Areig, Zaynab; Al Bayssari, Charbel; Bakour, Sofiane; Ali El Salabi, Allaaeddin; Ben Gwierif, Salha; Zorgani, Abdulaziz A; Ben Slama, Karim; Chouchani, Chedly; Rolain, Jean-Marc

    2015-06-01

    The aim of the present study was to investigate the molecular mechanism of carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii clinical isolates recovered from Libyan hospitals between April 2013 and April 2014. In total, 49 strains (24 P. aeruginosa and 25 A. baumannii) were isolated, including 21 P. aeruginosa and 22 A. baumannii isolates (87.75%) resistant to imipenem (minimum inhibitory concentrations ≥16 μg/ml). The blaVIM-2 gene was detected in 19 P. aeruginosa isolates. All imipenem-resistant P. aeruginosa isolates showed the presence of OprD mutations. Acquired OXA-carbapenemase-encoding genes were present in all A. baumannii isolates: blaOXA-23 (n=19) and blaOXA-24 (n=3). Finally, a total of 13 and 17 different sequence types were assigned to the 21 P. aeruginosa and the 22 A. baumannii carbapenem-resistant isolates, respectively. This study is the first report describing imipenem-resistant P. aeruginosa and A. baumannii isolated from patients in Libya. We report the first case of co-occurrence of blaVIM-2 with oprD porin loss in identical isolates of P. aeruginosa in Libya and demonstrate that these oprD mutations can be used as a tool to study the clonality in P. aeruginosa isolates. We also report the first identification of multidrug-resistant A. baumannii isolates harboring blaOXA-23-like, blaOXA-24-like, and blaOXA-48-like genes in Libya.

  16. Bacteremic nosocomial pneumonia caused by Acinetobacter baumannii and Acinetobacter nosocomialis: a single or two distinct clinical entities?

    Science.gov (United States)

    Lee, Y-T; Kuo, S-C; Yang, S-P; Lin, Y-T; Chiang, D-H; Tseng, F-C; Chen, T-L; Fung, C-P

    2013-07-01

    The phenotypically indistinguishable Acinetobacter baumannii and Acinetobacter nosocomialis have become leading pathogens causing nosocomial pneumonia in critically ill patients. A. baumannii and A. nosocomialis nosocomial pneumonias were grouped as a single clinical entity previously. This study aimed to determine whether they are the same or a different clinical entity. A total of 121 patients with A. baumannii and 131 with A. nosocomialis bacteremic nosocomial pneumonia were included during an 8-year period. Despite the similar Charlson co-morbidity scores at admission, patients with A. baumannii pneumonia were more likely to have abnormal haematological findings, lobar pneumonia, significantly higher Acute Physiology and Chronic Health Evaluation II scores and higher frequency of shock at the onset of bacteraemia than those with A. nosocomialis pneumoni. A. baumannii isolates were resistant to more classes of antimicrobials, except colistin, and therefore the patients with A. baumannii pneumonia were more likely to receive inappropriate antimicrobial therapy. The 14-day mortality was significantly higher in patients with A. baumannii pneumonia (34.7% vs. 15.3%, p 0.001). A. baumannii was an independent risk factor for mortality (OR, 2.03; 95% CI, 1.05-3.90; p 0.035) in the overall cohort after adjustment for other risk factors for death, including inappropriate antimicrobial therapy. The results demonstrated the difference in clinical presentation, microbial characteristics and outcomes between A. baumannii and A. nosocomialis nosocomial pneumonia, and supported that they are two distinct clinical entities.

  17. Pharmacokinetic/pharmacodynamic evaluation of sulbactam against Acinetobacter baumannii in in vitro and murine thigh and lung infection models.

    Science.gov (United States)

    Yokoyama, Yuta; Matsumoto, Kazuaki; Ikawa, Kazuro; Watanabe, Erika; Shigemi, Akari; Umezaki, Yasuhiro; Nakamura, Koyo; Ueno, Keiichiro; Morikawa, Norifumi; Takeda, Yasuo

    2014-06-01

    Acinetobacter baumannii is a pathogen that has become globally associated with nosocomial infections. Sulbactam, a potent inhibitor of β-lactamases, was previously shown to be active against A. baumannii strains in vitro and effective against A. baumannii infections. However, a pharmacokinetic/pharmacodynamic (PK/PD) analysis of sulbactam against A. baumannii infections has not yet been performed. This is necessary because optimisation of dosing regimens should be based on PK/PD analysis. Therefore, in vitro and in vivo PK/PD analyses of sulbactam were performed using murine thigh and lung infection models of A. baumannii to evaluate the pharmacokinetics and pharmacodynamics of sulbactam. Sulbactam showed time-dependent bactericidal activity in vitro against A. baumannii. The PK/PD index that best correlated with its in vivo effects was the time that the free drug concentration remained above the minimum inhibitory concentration (fT>MIC) both in the thigh (R(2)=0.95) and lung (R(2)=0.96) infection models. Values of fT>MIC for a static effect and 1, 2 and 3log10 kill, respectively, were 21.0%, 32.9%, 43.6% and 57.3% in the thigh infection model and 20.4%, 24.5%, 29.3% and 37.3% in the lung infection model. Here we report the in vitro and in vivo time-dependent activities of sulbactam against A. baumannii infection and demonstrate that sulbactam was sufficiently bactericidal when an fT>MIC of >60% against A. baumannii thigh infection and >40% against A. baumannii lung infection was achieved.

  18. Staphylococcus aureus isolates from chronic osteomyelitis are characterized by high host cell invasion and intracellular adaptation, but still induce inflammation.

    Science.gov (United States)

    Kalinka, Julia; Hachmeister, Marie; Geraci, Jennifer; Sordelli, Daniel; Hansen, Uwe; Niemann, Silke; Oetermann, Sylvia; Peters, Georg; Löffler, Bettina; Tuchscherr, Lorena

    2014-11-01

    Osteomyelitis is a severe inflammatory disease of the bone that is mainly caused by Staphylococcus aureus. Particularly, bone infections are difficult to treat and can develop into a chronic course with a high relapsing rate despite of antimicrobial treatments. The complex interaction of staphylococci with osseous tissue and the bacterial ability to invade host cells are thought to determine the severity of infection. Yet, defined bacterial virulence factors responsible for the pathogenesis of osteomyelitis have not been clearly identified. The aim of this study was to detect S. aureus virulence factors that are associated with osteomyelitis and contribute to a chronic course of infection. To this purpose, we collected 41 S. aureus isolates, each 11 from acute osteomyelitis (infection period less than 2 months), 10 from chronic osteomyelitis (infection period more than 12 months), 10 from sepsis and 10 from nasal colonization. All isolates were analyzed for gene expression and in functional in-vitro systems. Adhesion assays to bone matrix revealed that all isolates equally bound to matrix structures, but invasion assays in human osteoblasts showed a high invasive capacity of chronic osteomyelitis isolates. The high invasion rate could not be explained by defined adhesins, as all infecting strains expressed a multitude of adhesins that act together and determine the level of adhesion. Following host cell invasion isolates from chronic osteomyelitis induced less cytotoxicity than all other isolates and a higher percentage of Small-colony-variant (SCV)-formation, which represents an adaptation mechanism during long-term persistence. Isolates from acute and chronic osteomyelitis strongly produced biofilm and highly expressed agr and sarA that regulate secreted virulence factors and induced an inflammatory response in osteoblasts. In conclusion, chronic osteomyelitis isolates were characterized by a high host cell invasion rate, low cytotoxicity and the ability to

  19. Excellent Functionality Despite Clinico-Radiological Deformity in Osteomyelitis Variolosa - A Case Report.

    Science.gov (United States)

    Mugalur, Aakash; Shahane, Sunil M; Samant, Ashwin; Pathak, Aditya C; Reddy, Rajeev

    2015-01-01

    Despite the eradication of smallpox from the world in 1980 the osteo-articular sequelae of smallpox are still occasionally noticed in previously endemic areas. The sequelae of osteomyelitis variolosa may raise a diagnostic challenge to the untrained eyes of the surgeon. We present a case of "osteomyelitis variolosa" in a 70 years old patient. The patient had bilateral dislocation of the elbow joint with multidirectional instability. There was distortion of the articular surfaces and ankylosis of the bilateral proximal radio-ulnar joint. Hypoplasia of the right ulna with short fourth and fifth metacarpals of the left hand and hypoplasia of right fourth metacarpal with cortical thickening was noted radiologically. The patient had minimal disability of his elbows despite the striking radiological abnormality and was functionally independent.

  20. Treatment of radiation osteomyelitis of the mandible in a patient with acquired factor VIII inhibitor

    Energy Technology Data Exchange (ETDEWEB)

    Arimoto, Takamasa; Kishimoto, Hiromitsu; Matsumoto, Suwako; Kawanaka, Masao; Urabe, Masahiro; Yoshioka, Wataru [Hyogo Coll. of Medicine, Nishinomiya (Japan)

    1996-07-01

    A case of radiation osteomyelitis of mandible in a 56-year-old man with acquired factor VIII inhibitor is presented. He had undergone radiation therapy for malignant lymphoma of the tonsilar region seven years earlier, and also had received steroids to treat acquired factor VIII inhibitor for a year. On initial examination, he was given a diagnosis of phlegmon of the cheek caused by pericoronitis of the left lower wisdom tooth. To prevent the recurrence of inflammation, the wisdom tooth was extracted carefully, but radiation osteomyelitis occurred in association with a pathological fracture of the condylar head. After mini-pulse therapy with methylpredonisolone, segmental mandibulectomy and reconstruction with a titanium metal plate were performed. The postoperative course was satisfactory with no complications such as bleeding or infection. (author)

  1. Coccidioidomycosis osteomyelitis of the knee in a 23-year-old diabetic patient

    Directory of Open Access Journals (Sweden)

    Lowell Ellerbrook, BS

    2015-01-01

    Full Text Available Coccidioidomycosis is a pulmonary infection caused by the dimorphic fungi Coccidioides immitis and Coccidioidomycosis posadasii. This disease is endemic to the southwestern United States and has a predilection for immunocompromised patients. Diabetes mellitus has been shown to be a strong risk factor for acquiring this infection in these states. Most cases are asymptomatic or present with mild pulmonary symptoms. However, untreated pulmonary mycosis can lead to disseminated infection, most often involving meningitis, osteomyelitis, or skin and soft-tissue infections. When there is arthritis, the knee is the most common site of infection. We present a case of a 23-year-old male with longstanding, uncontrolled Type 1 diabetes mellitus who was found to have pulmonary coccidioidomycosis following diagnosis of coccidioidomycosis osteomyelitis of the knee.

  2. Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Sanjay P.; Zinkus, Timothy [Children' s Hospital Boston and Harvard Medical School, Division of Neuroradiology, Department of Pediatric Radiology, Boston, MA (United States); Cheng, Alan G. [Children' s Hospital Boston and Harvard Medical School, Department of Otolaryngology and Communication Enhancement, Boston, MA (United States); Stanford University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Stanford, CA (United States); Rahbar, Reza [Children' s Hospital Boston and Harvard Medical School, Department of Otolaryngology and Communication Enhancement, Boston, MA (United States)

    2009-09-15

    The fossa navicularis is a notch-like bone defect in the basiocciput that has been hitherto considered as an anatomical variant of the clivus and not previously described as a potential source of clival or skull base pathology. We report the imaging findings in a 5-year-old child who presented acutely with a retropharyngeal abscess and osteomyelitis of the clivus. Imaging after treatment revealed a ''notch-like'' defect in the anterior clivus consistent with a fossa navicularis. Based on these appearances, we postulate that the lymphoid tissue of the pharyngeal tonsil residing in the fossa navicularis served as a route through which infection spread and subsequently developed into clival osteomyelitis, which is a rare diagnosis. This case is unique, and we believe that the presence of this variant in young children may be important and is not merely an anatomical curiosity. (orig.)

  3. RECONSTRUCTIVE MICROSURGERY IN THE TREATMENT OF SURFACE FORMS OF CALCANEal OSTEOMYELITIS

    Directory of Open Access Journals (Sweden)

    E. S. Tsybul’

    2016-01-01

    Full Text Available One of the most common complications associated with the treatment of calcaneus fracturesis, a necrosis of the edges of the surgical wound and as a result – chronic nonhealing ulcers of the heel region and osteomyelitis of the calcaneus. In the structure of skeletal lesions osteomyelitic chronic osteomyelitis of the calcaneus occurs in 3.1–14.8% of cases, and in relation to the bones of the foot – up to 51%. At the same time after open fractures of the total incidence of deep infection from soft tissue even higher than that for the surface (12.2% vs. 9.6%. The traditional approach to the treatment of osteomyelitis of the calcaneus is often accompanied by poor performance with recurrent osteomyelitis process and highsubsequent disability of working age.Objective: to identify opportunities and assess the effectiveness of the use of reconstructive microsurgery techniques in the treatment of patients with superficial forms of osteomyelitis of the calcaneus, accompanied by the presence of soft tissue defect.Materials and мethods.The results of treatment of 28 patients with superficial forms of osteomyelitis of the calcaneus, which in the period from 2006 to 2013 in RNIITO them. R.R.Vredena were performed reconstructive plastic surgery using microsurgical techniques. Defects covering tissues were located on the sole (20 and back-side surfaces (8 of the calcaneus. Scope of interventions included the radical surgical treatment of osteomyelitis focus, marginal resection of the affected heel bone and tissue replacement of defect cover flap with axial blood supply.Results. With the localization of the defect cover tissues to non-reference surface of the heel region was carried out free plastic ray skin-fascial flap (9 cases. When the location of the defect on the plantar surface of the heel region favored medial plantar flap (10 cases. However, the presence of scarring and damage to the medial plantar artery was performed

  4. Biofilm in Osteomyelitis caused by a Rare Pathogen, Morganella morganii : A Case Report.

    Science.gov (United States)

    De, Asmita; Raj, Hirak Jyoti; Maiti, Prasanta Kumar

    2016-06-01

    Morganella morganii is a member of Enterobacteriaceae family, whose natural habitat is the human gastrointestinal tract. It rarely causes infection alone and is generally encountered in immunosuppressed patients. Osteoarticular pathologies are not commonly observed with Morganella morganii and infections by it have high mortality rate. Biofilm colonization is a causative factor behind the chronicity and/or refractoriness of certain infections. Biofilms colonize on inert medical devices, prosthesis, fibrosed tissues, sinus tracts as well as dead bones as in case of chronic osteomyelitis. Morganella morganii is not a common pathogen to produce biofilm. In this case report, we present a 56-year-old male patient with chronic osteomyelitis of right proximal tibia caused by biofilm producing strain of Morganella morganii, following trauma.

  5. Skull involvement in a pediatric case of chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Watanabe, Toru; Ono, Hiroyuki; Morimoto, Yoshitaka; Otsuki, Yoshiro; Shirai, Masami; Endoh, Akira; Naito, Masaaki; Inoue, Yoshiya; Hongo, Teruaki

    2015-08-01

    An 11-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis (CRMO) and presented with right sacro-femoral and occipital lesions. Initially, a tumor was suspected. However, the bone biopsy showed osteomyelitis with a negative bacterial culture. Bone scintigraphy revealed inflammatory changes on multiple bone lesions. The slight elevation in inflammatory markers such as C-reactive protein was of little clinical value. He was diagnosed with CRMO by sacral biopsy, and the clinical course progressed, with the presence of a new occipital lesion observed after the 1-year follow-up. The administration of non-steroidal anti-inflammatory drugs successfully improved his clinical symptoms. The presence of a skull lesion in the occipital bone of a pediatric patient with CRMO has not been previously reported.

  6. Acute osteomyelitis of the acetabulum induced by Staphylococcus capitis in a young athlete

    Directory of Open Access Journals (Sweden)

    Seiji Fukuda

    2010-03-01

    Full Text Available Acute hematogenous osteomyelitis (AHOM of the acetabulum is a rare condition in children and usually caused by Staphylococcus aureus. We present an 11-year-old soccer athlete who suffered from acute osteomyelitis involving the acetabulum caused by S. capitis, a normal flora of the human skin but never reported in this condition. The disease was associated with repetitive skin injuries of the knee and potential osseous microtrauma of the hip joint by frequent rigorous exercise. This unusual case suggests that osseous microtrauma of the acetabulum, in addition to repetitive skin injuries, allowed normal skin flora to colonize to the ipsilateral acetabulum, which served as a favorable niche and subsequently led to AHOM.

  7. [Vertebral osteomyelitis caused by Streptococcus agalactiae in healthy adults. Description of 2 new cases].

    Science.gov (United States)

    Rivero Marcotegui, M; Hidalgo Ovejero, A; Lecumberri, M Cía; Otermin Maya, I; Pereda García, A

    2009-10-01

    The importance of Streptococcus agalactiae as a pathogen in nonpregnant adults has been widely recognized in recent years, especially in the elderly or immunocompromised patients. Two cases of vertebral osteomyelitis caused by S. agalactiae in young patients with no known underlying diseases or predisposing factor to infection are reported. A systematic review of the literature (MEDLINE, 1976-May 2008) was performed, 10 cases previously reported in the literature of vertebral osteomyelitis due to S. agalactiae being found in adults under 65 years of age with no predisposing risk factors for infection, most of which have been reported over the last 10 years. We believe that this microbial etiology should be considered in patients of any age and immunological status. Other factors, other than increasing the number of patients with chronic diseases, explaining the increased rate of S. agalactiae infections in adults need to be studied.

  8. Chronic Sclerosing Osteomyelitis of the Mandible Treated with Hemimandibulectomy and Fibular Free Flap Reconstruction.

    Science.gov (United States)

    Singh, Shubhi; Graham, M Elise; Bullock, Martin; Rigby, M H; Taylor, S Mark; Trites, Jonathan R B; Hart, Robert D

    2015-12-01

    Primary chronic osteomyelitis of the mandible is a rare condition that presents with a long-standing chronic facial swelling over the mandible, pain with mastication, and trismus. With no clinically appreciated acute phase, the aetiology often remains unknown. Many patients achieve adequate symptom control with broad-spectrum antibiotics, hyperbaric oxygen therapy and surgical debridement, or decortication of bone sequestration. However, because of the rarity of primary chronic osteomyelitis and the extensive involvement of the mandible that can result, we present a case of a 32-year-old woman with chronic disease of the left mandible requiring a left hemimandibulectomy and fibular free flap reconstruction. Few such cases have been reported in the literature, which require such extensive resection and reconstruction to control long-standing symptoms.

  9. Osteomyelitis Infection of Mycobacterium marinum: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Hao H. Nguyen

    2015-01-01

    Full Text Available Mycobacterium marinum (M. marinum is a ubiquitous waterborne organism that grows optimally at temperatures around 30°C. It is a nontuberculous Mycobacterium found in nonchlorinated water with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. M. marinum can cause superficial infections and localized invasive infections in humans, with the hands being the sites most frequently affected. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity, or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We here report a case of severe deep soft tissue infection with necrotizing fasciitis and osteomyelitis of the left upper extremity (LUE caused by M. marinum in an immunocompromised patient.

  10. Antimicrobial blue light therapy for multidrug-resistant Acinetobacter baumannii infection in a mouse burn model: implications for prophylaxis and treatment of combat-related wound infections.

    Science.gov (United States)

    Zhang, Yunsong; Zhu, Yingbo; Gupta, Asheesh; Huang, Yingying; Murray, Clinton K; Vrahas, Mark S; Sherwood, Margaret E; Baer, David G; Hamblin, Michael R; Dai, Tianhong

    2014-06-15

    In this study, we investigated the utility of antimicrobial blue light therapy for multidrug-resistant Acinetobacter baumannii infection in a mouse burn model. A bioluminescent clinical isolate of multidrug-resistant A. baumannii was obtained. The susceptibility of A. baumannii to blue light (415 nm)-inactivation was compared in vitro to that of human keratinocytes. Repeated cycles of sublethal inactivation of bacterial by blue light were performed to investigate the potential resistance development of A. baumannii to blue light. A mouse model of third degree burn infected with A. baumannii was developed. A single exposure of blue light was initiated 30 minutes after bacterial inoculation to inactivate A. baumannii in mouse burns. It was found that the multidrug-resistant A. baumannii strain was significantly more susceptible than keratinocytes to blue light inactivation. Transmission electron microscopy revealed blue light-induced ultrastructural damage in A. baumannii cells. Fluorescence spectroscopy suggested that endogenous porphyrins exist in A. baumannii cells. Blue light at an exposure of 55.8 J/cm(2) significantly reduced the bacterial burden in mouse burns. No resistance development to blue light inactivation was observed in A. baumannii after 10 cycles of sublethal inactivation of bacteria. No significant DNA damage was detected in mouse skin by means of a skin TUNEL assay after a blue light exposure of 195 J/cm(2).

  11. Results of immunoscintigraphy of osteomyelitis (LeukoScan) {sup trademark}; Ergebnisse zur Immunszintigraphie der Osteomyelitis (LeukoScan) {sup trademark}

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, S.; Becker, W. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin

    2000-05-01

    99mTc-labeled antigranulocyte monoclonal antibody Fab' fragments have shown a high sensitivity and specificity for detecting osteomyelitis in prospective studies. We retrospectively evaluated the use of LeukoScan {sup trademark} (Immunomedics, Morris Plains, N.J.) in clinical routine for the detection of bone and soft tissue infections and we want to present the results of our findings as well as some of the more interesting cases in this occasion. Imaging infection can be performed fast and easy with {sup 99m}Tc-Fab' fragments due to a fast targeting of infection and good background clearance, which increases in imaging quality. The application of {sup 99m}Tc-Fab' fragments gives good results in patients with bone and soft tissue infections of peripheral bones, as well as in patients with infected prostheses and infected arthritis. The use of {sup 99m}Tc-Fab' fragments should not be limited to these patients only, since good results can also be achieved in patients with infections of vascular grafts, of appendicitis and of endocarditis as well. A higher number of false-negative results has to be expected in case of subacute/chronic infections instead. Independent of the grade of infection acute/subacute infections of the spine always show 'cold lesions'. If cold lesions are used as guide for diagnosing a pathologic finding, an increase in sensitivity together with a decrease in specificity can be achieved. (orig.) [German] {sup 99m}Tc-markierte Antigranulozytenantikoerper-Fab'-Fragmente konnten in prospektiven Studien eine hohe Sensitivitaet und Spezifitaet bei der Detektion von Osteomyelitiden unter Beweis stellen. Retrospektiv haben wir die Anwendung von {sup 99m}Tc-markierten Fab'-Fragmenten ({sup 99m}Tc-Fab') (LeukoScan {sup trademark}, Immunomedics, Morris Plains, N.J.) in der klinischen Routine zum Nachweis von Knochen- und Weichteilentzuendungen ausgewertet und moechten einen Teil unserer Ergebnisse sowie einige

  12. Vertebral Osteomyelitis: An Under-Recognized Infectious Complication in Patients on Home Parenteral Nutrition

    OpenAIRE

    Huard, Genevieve; Bouin, Mickael; Lemoyne, Michel; D’Aoust, Louise

    2014-01-01

    Background Patients on home parenteral nutrition (HPN) are at high risk of central venous catheter sepsis (CVCS). CVCS can be associated with distant bacterial seeding. However, few cases of vertebral osteomyelitis (VO) related to HPN have been reported. For this reason, we made the hypothesis that the incidence of VO in patients on HPN is probably higher than what is reported. The goal of this study was to evaluate the incidence of infectious complications, and more specifically, the inciden...

  13. Osteomyelitis of the condyle secondary to pericoronitis of a third molar: a case and literature review.

    Science.gov (United States)

    Wang, R; Cai, Y; Zhao, Y F; Zhao, J H

    2014-09-01

    In this study, we report a very unusual case of a patient with osteomyelitis of the condyle secondary to pericoronitis of an impacted third molar. The patient was treated by removal of the impacted third molar, opening of the drainage, combined with systemic application of antibiotics for two weeks. This treatment option did not lead to any functional defects or facial asymmetry. The patient fully recovered and the disease did not recur.

  14. Travel-Associated Salmonella mbandaka Sacroiliac Osteomyelitis in a Healthy Adolescent

    Directory of Open Access Journals (Sweden)

    Kirsty Le Doare

    2013-01-01

    Full Text Available Pyogenic infections of the sacroiliac joint are rare and usually caused by Staphylococcus aureus. We describe a case of a 16 year-old gymnast who was subsequently diagnosed with Salmonella mbandaka sacroiliac osteomyelitis with adjacent psoas abscess and hepatitis one week after returning from a holiday in Crete. This case highlights a rare presentation of a common travel-associated foodborne infection.

  15. Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2011-05-01

    Full Text Available Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and osteomyelitis in a diabetic patient.

  16. Chronic recurrent multifocal osteomyelitis demonstrated by Tc-99m methylene diphosphonate bone scan

    DEFF Research Database (Denmark)

    Lise, Hobolt; Nemery, Michel; Albrectsen, Jens;

    2008-01-01

    A 12-year-old Middle Eastern girl presented with abdominal pain, weight loss, and intermittent pain in both thighs. She was initially suspected of Crohn disease, but this diagnosis was excluded after extensive gastromedical evaluation. Plain x-rays of the femora were normal, whereas the initial T...... osteomyelitis (CRMO). The patient's symptoms disappeared spontaneously, but reappeared 1.5 years later, which led to a new MDP bone scan that showed normal findings. Udgivelsesdato: 2008-Jan...

  17. Postoperative osteomyelitis following implant arthroplasty of the foot: diagnosis with indium-111 white blood cell scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Bakst, R.H.; Kanat, I.O.

    1987-11-01

    Many complications can occur following insertion of silicone elastomer implants into the foot. Postoperative infection may be difficult to distinguish from other conditions such as dislodgment, fracture, ectopic and heterotopic new bone formation, synovitis, and bursitis. White blood cell scintigraphy, in conjunction with the clinical scenario, may prove to be an invaluable tool in the diagnosis of postoperative osteomyelitis, subsequent to implant arthroplasties. 32 references.

  18. Osteomyelitis and Discitis Following Translumbar Repair of a Type II Endoleak

    Energy Technology Data Exchange (ETDEWEB)

    Sella, David M., E-mail: Sella.david@mayo.edu; Frey, Gregory T., E-mail: Frey.gregory@mayo.edu; Giesbrandt, Kirk, E-mail: giesbrandt.kirk@mayo.edu [Mayo Clinic, Department of Radiology (United States)

    2016-03-15

    Here we present the case of an 80-year-old man who developed a type II endoleak following endovascular abdominal aortic aneurysm repair. Initial attempts at treating the endoleak via a transarterial approach were unsuccessful; therefore the patient underwent percutaneous translumbar endoleak embolization. Approximately 1 month following the translumbar procedure, he developed back pain, with subsequent workup revealing osteomyelitis and discitis as a complication following repair via the translumbar approach.

  19. Risk factors for mortality in Acinetobacter calcoaceticus-baumannii bacteraemia

    Institute of Scientific and Technical Information of China (English)

    Asmita A Mehta; V Anil Kumar; Kumari Indira K; Suresh G Nair; Kavitha R Dinesh; Sanjeev K Singh

    2012-01-01

    Objective: To determine the risk factors associated with mortality in Acinetobacter calcoaceticus–baumannii (Acb) complex blood stream infection. Methods: This was an observational study conducted in tertiary care hospital of South India. All patients with blood culture positive for Acb complex from January 2008 to December 2009 were included and a standardized abstraction form was used to abstract data. P value was calculated by Chi square test. Univariate analysis was done by using 2x2 tables and the variables with P value of <0.1 were further subjected to multivariate analysis. Multivariate analysis was done by logistic regression method. Results: After excluding the polymicrobial infections and duplicate isolates from the same patients, 81 cases were included in our study. Out of 81 patients, 20 (24.6%) patients had positive isolate from body secretion other than blood for Acb complex, majority were hospitalized in intensive care unit (74%), had indwelling vascular catheters (68%) and were mechanically ventilated (61%). Multi drug resistant phenotypes were seen in 56 (69.1%) isolates and among them 13 (16%) were resistant to carbapenems. Univariate analysis showed renal disease, diabetes mellitus, use of mechanical ventilation and absence of appropriate antibiotic therapy, leucopenia, thrombocytopenia and raised prothrombin time were related to increased mortality in Acb complex bacteraemia. However, in multivariate analysis independent risk factors for mortality in Acb complex bacteraemia were platelets of less than 1.5 lacks and inappropriate empirical antibiotics. Conclusions: Thrombocytopenia and absence of appropriate antibiotics were risk factors associated with mortality in Acb bacteraemia. Patients with blood culture showing Acb complex bacteraemia with above findings should be attended with aggressive management. Clinician of hospitals with high incidence of Acb complex bacteraemia, should predict the chances of such infection even prior to blood

  20. Morphine, but not trauma, sensitizes to systemic Acinetobacter baumannii infection.

    Science.gov (United States)

    Breslow, Jessica M; Monroy, M Alexandra; Daly, John M; Meissler, Joseph J; Gaughan, John; Adler, Martin W; Eisenstein, Toby K

    2011-12-01

    Acinetobacter baumannii is an important nosocomial pathogen in civilian intensive care units. Recently the incidence has increased in wounded military personnel. Morphine is documented in numerous animal studies to be immunosuppressive and to sensitize to infection. The hypotheses were tested that morphine, administered for analgesia in the battlefield, predisposes to Acinetobacter infection, and that the opioid may have an additive or synergistic effect with trauma. To test these hypotheses, an intraperitoneal infection model was established in mice using several Acinetobacter strains. Morphine administered for 48 h by implantation of a slow-release morphine pellet increased mortality compared to animals receiving a placebo pellet, an effect that was blocked by the mu-opioid receptor antagonist, naltrexone. Acinetobacter burdens in the blood, spleens, livers, and lungs of morphine-treated mice, were significantly higher than those in placebo-treated animals, confirming that mortality was due to potentiated growth of the bacteria. There were also elevated levels of pro-inflammatory cytokines in morphine-treated versus placebo-treated mice. Morphine caused a reduction in the total number of cells in the peritoneal cavity, a decrease in the percentage and total numbers of neutrophils, and a decrease in the total number of macrophages. Morphine treatment also suppressed levels of the neutrophil-inducing molecules, IL-17A and KC/CXCL1. However, IL-17A(-/-) mice given morphine were not sensitized to Acintobacter infection to a greater degree than similarly treated wild-type mice. Trauma alone did not sensitize to Acinetobacter infection, and there was no additive effect between morphine and trauma. These results support the hypothesis that morphine potentiates Acinetobacter infection.