Intravenous fosfomycin as salvage therapy for osteomyelitis caused by multidrug-resistant Pseudomonas aeruginosa

2021 ◽  
Author(s):  
Maggie Wong ◽  
Davie Wong ◽  
Sangita Malhotra
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Salvage Therapy ◽  
Wound Care ◽  
Multidrug Resistant ◽  
Wound Culture ◽  
History Of ◽  
Artery Disease ◽  
Oral Ciprofloxacin ◽  
Oral Metronidazole

Abstract Purpose A case of osteomyelitis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa is reported. Summary An 84-year-old Caucasian male with an underlying history of type 2 diabetes, peripheral vascular disease, and coronary artery disease had chronic nonhealing wounds on his right foot. Wound care and a course of intravenous (IV) ertapenem with oral ciprofloxacin were ineffective. His initial wound culture grew Staphylococcus aureus, group G streptococcus and P. aeruginosa; the Pseudomonas was susceptible to multiple agents. The patient eventually required midtarsal amputation and angioplasties to his right leg. Twenty days after the operation, 2 openings were discovered at the surgical site, 1 of which was probed to the bone. He was readmitted 5 weeks after the operation. A repeat wound swab grew MDR P. aeruginosa and Finegoldia magna. The Pseudomonas was susceptible to gentamicin and colistin. The patient had revision of the infected amputation site with the goal of salvaging his right lower limb. The patient developed acute renal failure after 26 days of IV gentamicin, IV ceftriaxone, and oral metronidazole. Additional susceptibility testing was performed to identify alternatives. The bacteria were considered susceptible to IV fosfomycin, the last resort, by our microbiology laboratory. This was combined with ceftolozane/tazobactam followed by meropenem to treat the residual infection. After 2 weeks of IV fosfomycin, the patient’s wound improved and further amputation was avoided. Conclusion Our case demonstrates that IV fosfomycin may provide an effective salvage therapy when combined with β-lactams for the treatment of severe diabetic foot infection or osteomyelitis caused by MDR P. aeruginosa.

Primary lung abscess due to multidrug-resistant Klebsiella pneumoniae

2021 ◽  
Vol 14 (9) ◽  
pp. e244759
Author(s):  
Mascarenhas Chrystle ◽  
Acharya Vishak ◽  
Kamath Sindhu ◽  
Mendonca Jane
Keyword(s):  
Klebsiella Pneumoniae ◽  
Unusual Case ◽  
Early Recognition ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
Drug Resistant ◽  
Management Guidelines ◽  
History Of

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.

Possible GoLytely-Associated Cardiac Arrest: A Case Report and Literature Review

2019 ◽  
Vol 33 (3) ◽  
pp. 364-367 ◽  
Author(s):  
Yoonsun Mo ◽  
Shiv Gandhi ◽  
Jose Orsini
Keyword(s):  
Cardiac Arrest ◽  
Abdominal Pain ◽  
Sudden Cardiac Arrest ◽  
Lower Abdominal Pain ◽  
The Past ◽  
Life Threatening ◽  
History Of ◽  
Artery Disease ◽  
Possible Cause

Purpose: To report a case of sudden cardiac arrest possibly associated with the administration of GoLytely® (polyethylene glycol 3350 and electrolytes). Summary: A 60-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presented to the emergency department with complaints of constipation and lower abdominal pain over the past week, and the inability to urinate over the past day. The patient had received GoLytely as treatment to alleviate symptoms of constipation and abdominal pain. However, several hours after administration of the bowel prep solution, the patient suffered an episode of cardiac arrest. After ruling out other possible etiologies, GoLytely was suspected as a possible cause of cardiac arrest. The patient had suffered an anoxic brain injury and remained intubated and unconscious until he eventually expired, 20 days after the event. Conclusion: Although GoLytely appears to be a safe agent with fewer side effects, clinicians need to be mindful of potential life-threatening adverse events following GoLytely administration and monitor patients closely during and after administration.

Systematic Review of the Epidemiology and Natural History of the Metabolic Vascular Syndrome and its Coincidence with Type 2 Diabetes Mellitus and Cardiovascular Diseases in Different European Countries

2017 ◽  
Vol 50 (03) ◽  
pp. 201-208 ◽  
Author(s):  
Caroline Kwasny ◽  
Ulf Manuwald ◽  
Joachim Kugler ◽  
Ulrike Rothe
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
United Kingdom ◽  
Cardiovascular Diseases ◽  
Natural History ◽  
European Countries ◽  
History Of ◽  
Artery Disease ◽  
The Many

AbstractThe objectives of this systematic review were to estimate the incidence, prevalence and natural history of the metabolic (vascular) syndrome (MVS) among adults in different European countries. Furthermore, we assessed its co-incidence with type 2 diabetes (T2DM) and cardiovascular diseases (CVD). PubMed, MedLine, and EMBASE (via Ovid) were searched for relevant studies. After reading 116 full-text articles to find eligible ones, 66 publications met our inclusion criteria. Data for the incidence are based on a study from Portugal, in which the incidence rate for the MVS was 47.2/1000 person-years. Prevalence varied strongly depending on country and definition. The lowest was found in the United Kingdom (3%), the highest in Finland (71.7%). No article that deals with the natural history of the MVS was found. Considering the co-existence of MVS and T2DM, it ranged between 2% (United Kingdom) and 74.4% (Spain). The co-occurrence of MVS and CVD ranged from 2.8% (Italy) up to 52% (Netherlands). Coronary heart disease (CHD) varied between 1.2% and 44.2%. With regard to peripheral artery disease (PAD), values between 3.3% and 59.8% were found. Due to the many different definitions of the MVS, a comparison is very difficult. Overall prevalence ranged between 3% and 71.7% depending on definition, age, and country. An association between MVS and T2DM as well as several CVD can be assumed.

scholarly journals Obesity and Covid-19: A Major Mortality Risk in Patients Hospitalized With Covid-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A53-A53
Author(s):  
Giovanna Rodriguez ◽  
Eunice Kim ◽  
Fausto Cabezas ◽  
Paulomi Dave ◽  
Jefferson Li ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Normal Weight ◽  
Health Crisis ◽  
City Community ◽  
Patients With Diabetes ◽  
History Of ◽  
Artery Disease

Abstract The coronavirus disease 2019 COVID-19 pandemic is a major public health crisis. Obesity has emerged as a significant comorbidity for COVID-19 severity. To study the association of both pandemics, we conducted an observational, retrospective cohort study involving 521 patients admitted with Covid-19 to an inner city, community hospital in Brooklyn, NY in the period March 20 to May 2, 2020. Of the cohort, 57.6% was men, mean age was 61.6±17.2 years, and mean BMI was 29.0 ± 8.2 kg /m2. 11% had BMI > 40 kg/m2. 53.9% was Hispanic, 33.3% was African American, 7.1% was White, with a predominance of type 2 diabetes (99%). Diabetes, hypertension, coronary artery disease and chronic kidney disease were found in 45%, 41.5%, 15%, and 20.1% cases, respectively. Mean HbA1c was 5.8%± 1.1 in patients with no history of diabetes, 3% presented with diabetic ketoacidosis, mortality rate was 30.6%. Non-survivors were significantly older (median age 68 vs 56, p < 0.03) and had higher rate of microvascular and macrovascular diseases. In patients with diabetes, mortality rate was 40.1%. HbA1c was similar between survivors and non-survivors. Older age and hyperglycemia on admission were the risk factors for mortality. Only 30% of the cohort had normal weight (BMI<25), 30% was overweight and 40% was obese. In univariate analysis, the characteristics at admission significantly associated with mortality were age, BMI, hyperglycemia, diabetes and DKA in patients with or without diabetes. In age- and sex-adjusted multivariable analysis only BMI 30–39 kg/m2 (OR = 1.63; 95% CI, 1.10, 2.43; p = 0.015), BMI >40 kg/m2 (OR = 2.05; 95% CI, 1.22, 3.44; p = 0.007) and DKA (OR = 1.77; 95% CI, 1.18, 2.64; p = 0.005) remained positively associated with higher mortality. In summary, BMI, and DKA but not diabetes, were positively and independently associated with mortality in patients hospitalized with Covid-19. Reference: (1) Popkin et al., Obesity Reviews 2020 August;21(11):e13128. (2) Cariou et al., Diabetologia 2020 May;63(8): 1500–1515.

scholarly journals Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Ewelina A. Dziedzic ◽  
Jakub S. Gąsior ◽  
Mariusz Pawłowski ◽  
Marek Dąbrowski
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Cardiac Patients ◽  
Coronary Syndrome ◽  
Patients With Diabetes ◽  
History Of ◽  
Artery Disease

Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p<0.01). Significantly lower level of the 25(OH)D was observed in patients hospitalized due to acute coronary syndrome (ACS) in comparison to patients hospitalized due to stable CAD (p<0.001). Lower 25(OH)D levels were observed in patients with the history of myocardial infarction (MI) in comparison to patients without previous MI (p<0.001). In cardiac patients with diabetes, the higher number of stenotic coronary arteries is associated with lower values of the 25(OH)D. A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.

Cardiovascular risk and missed opportunities for treatment in patients with type 2 diabetes presenting with very premature coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Vikulova ◽  
C Brown ◽  
E Theberge ◽  
G.B.J Mancini ◽  
S.N Pimstone ◽  
...  
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Premature Coronary Artery Disease ◽  
Funding Source ◽  
Newly Diagnosed ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease ◽  
Time Of Presentation

Abstract Background Type 2 diabetes mellitus (T2D) is a major cardiovascular risk factor (CVRF), and comprehensive risk factor management reduces the incidence of cardiovascular events. Purpose To assess 1) prevalence of T2D among patients presenting with newly diagnosed very premature coronary artery disease (CAD) and its impact on CVRFs and extent of atherosclerosis; 2) effectiveness of glucose and lipid control in T2D patients before presentation with CAD. Methods We studied patients with angiographically proven CAD with stenosis of ≥50% who presented at the age of ≤50 years for males and ≤55 years for females. Diabetes was defined as fasting plasma glucose ≥7 mmol/L, haemoglobin (Hb)A1C ≥6.5% or diagnosis or treatment of T2D before or at presentation with CAD. CVRFs were defined as dyslipidemia, hypertension, obesity, current smoking, and family history of premature cardiovascular disease (CVD). Values are reported as mean (±SD), median (interquartile range) or percentages. Results From 417 premature CAD patients, 112 (26.9%) had T2D at the time of presentation with CAD. In 27 (24.1%) patients, T2D was newly diagnosed at presentation with CAD. Age of diagnosis of T2D was 41.3 (±6.9) years old. Patients with T2D had higher prevalence of dyslipidemia (83.0% vs 63.3%, p&lt;0.001), hypertension (65.2% vs 40.3%, p&lt;0.001), and obesity (56.3% vs 34.8%, p&lt;0.001), higher cumulative number of CVRFs per person (2.8 (±1.2) vs 2.0 (±1.2), p&lt;0.001) and less favourable lipid profiles, with higher levels of triglycerides (3.3 (2.1–4.7) vs 2.3 (1.5–3.4) mmol/L, p=0.001) and lower HDL-cholesterol (0.9 (±0.3) vs 1.1 (±0.3) mmol/L). Prevalence of smoking (32.1% vs 24.9%, p=0.14) and family history of premature CVD (43.8% vs 39.7%, p=0.45), levels of LDL-cholesterol (3.7 (±1.4) vs 3.8 (±1.2) mmol/L, p=0.23) and lipoprotein(a) (206 (99–819) vs 200 (99–700) mg/L, p=0.57) were not significantly different between groups. T2D patients had a greater prevalence of 3-vessel disease (35.7% vs. 22.2%, p=0.006) and were less likely to receive revascularization (70.5% vs 83.9%, p=0.002). Prior to presentation with CAD, 31 (27.7%) of T2D patients received insulin, 42 (37.5%) received oral hypoglycemic drugs, and 12 (10.7%) received no pharmacological treatment for diabetes. Only 23 (27.1%) of them achieved HbA1C ≤7% at the time of presentation with CAD (Figure 1). Among all T2D patients, 35 (31.3%) received treatment with statins and 16 (14.3%) reached guideline-recommended lipid targets of LDL cholesterol ≤2 mmol/L and/or non-HDL cholesterol ≤2.6 mmol/L. Conclusion Among patients with very premature CAD, T2D was common, was previously unrecognized in up to one quarter, and was associated with a greater burden of CVRFs and more extensive CAD at presentation. Few patients with T2D achieved guideline-recommended lipid or glucose targets. These data point to the need for improvements in screening and comprehensive CVRF treatment of T2D in order to reduce the burden of premature CAD. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research. St. Paul's Hospital Foundation and the Vancouver General Hospital Foundation

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