scholarly journals Tibial Osteomyelitis Caused by Carbapenem-Resistant Enterobacter cloacae

2020 ◽  
Vol 3 (1) ◽  
pp. 16-24
Author(s):  
David J. Cinats ◽  
Evgeny Strovski ◽  
Cheng-Han Lee ◽  
Darius Viskontas
Keyword(s):  
Enterobacter Cloacae ◽  
Tibia Fracture ◽  
Non Union ◽  
Proximal Fibula ◽  
Carbapenem Resistant ◽  
Management Protocol ◽  
Initial Injury ◽  
Open Tibia Fracture ◽  
Post Traumatic ◽  
Antibiotic Spacer

A 31-year-old man presented with a symptomatic tibial non-union following an open tibia fracture sustained in India. The open fracture was persistently draining for 8 months following the initial injury. The decision was made to revise his tibia fracture to promote union. Intraoperative cultures of the non-union site during the revision procedure revealed osteomyelitis caused by carbapenemase-producing Enterobacter cloacae which was multi-drug resistant to all antibiotics except for tigecycline. The patient was treated successfully with a tigecycline-impregnated antibiotic spacer and intravenous tigecycline with repeat bone cultures demonstrating eradication of the infection. Eight weeks into treatment (1 year from initial injury), the patient developed new pain and swelling in the adjacent proximal fibula of the limb treated for osteomyelitis. MRI and biopsy revealed Ewing sarcoma. The patient underwent transfemoral amputation. This report describes a management protocol of carbapenemase-resistant post-traumatic osteomyelitis with no evidence of infection recurrence.

scholarly journals The functional outcome and quality of life following open diaphyseal tibial fractures

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Nazri Mohd Yusof ◽  
Mohd Shahidan Noor Rahin
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Open Fracture ◽  
Tibia Fracture ◽  
Tibial Fractures ◽  
Functional Score ◽  
Non Union ◽  
Open Tibia Fracture ◽  
Grade Ii

Introduction: The clinical outcome of open tibia fracture been extensively studied in many institutions. However, the functional outcome and quality of life has not been widely studied. The aim of this study is to evaluate the functional outcome and quality of life for patients with open tibia fracture that were treated in Hospital Tengku Ampuan Afzan. Methods: Between 2009 and 2010, we treated 33 patients with open diaphyseal tibial fractures with a minimum period of one year follow up. There were 31 males and 2 females; the mean age of 29 years old (range: 10 to 60). Four patients sustained open fracture grade I, 13 grade II, 12 grade IIIA and 4 with grade IIIB. All patients who fulfill the inclusion criteria were called for interview in the clinic by the investigator. The outcome that were analyzed include health related quality of life (SF36) and Lower Extremity Functional Score (LEFS). Results: All except one fracture achieve union. One patient with grade IIIB open fracture developed infected non union. Quality of life is satisfactory in all domains. The functional outcome score was significantly reduced in grade IIIB (48.5) as compare to other grade (grade I 74.2, grade II 70.4, grade IIIA 74.1). Conclusions: The quality of life and the functional outcome worsened with increasing severity of fracture.

scholarly journals Characterization of resistance mechanisms of Enterobacter cloacae Complex co-resistant to carbapenem and colistin

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shixing Liu ◽  
Renchi Fang ◽  
Ying Zhang ◽  
Lijiang Chen ◽  
Na Huang ◽  
...  
Keyword(s):  
Lipid A ◽  
Efflux Pump ◽  
Resistance Mechanism ◽  
Carbapenem Resistance ◽  
Enterobacter Cloacae ◽  
Resistance Mechanisms ◽  
Colistin Resistance ◽  
Carbapenem Resistant ◽  
Horizontal Spread

Abstract Background The emergence of carbapenem-resistant and colistin-resistant ECC pose a huge challenge to infection control. The purpose of this study was to clarify the mechanism of the carbapenems and colistin co-resistance in Enterobacter cloacae Complex (ECC) strains. Results This study showed that the mechanisms of carbapenem resistance in this study are: 1. Generating carbapenemase (7 of 19); 2. The production of AmpC or ESBLs combined with decreased expression of out membrane protein (12 of 19). hsp60 sequence analysis suggested 10 of 19 the strains belong to colistin hetero-resistant clusters and the mechanism of colistin resistance is increasing expression of acrA in the efflux pump AcrAB-TolC alone (18 of 19) or accompanied by a decrease of affinity between colistin and outer membrane caused by the modification of lipid A (14 of 19). Moreover, an ECC strain co-harboring plasmid-mediated mcr-4.3 and blaNDM-1 has been found. Conclusions This study suggested that there is no overlap between the resistance mechanism of co-resistant ECC strains to carbapenem and colistin. However, the emergence of strain co-harboring plasmid-mediated resistance genes indicated that ECC is a potential carrier for the horizontal spread of carbapenems and colistin resistance.

ULNAR-SIDED WRIST PAIN AFTER FOUR-CORNER FUSION IN A PREVIOUSLY-ASYMPTOMATIC ULNAR POSITIVE WRIST: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 49-51 ◽  
Author(s):  
Hyun Sik Gong ◽  
Su Ha Jeon ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Wrist Pain ◽  
Stage Ii ◽  
Treatment Choices ◽  
Non Union ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Post Traumatic ◽  
Snac Wrist

Scaphoid excision and four-corner fusion is one of the treatment choices for patients who have stage II or III SLAC (scapholunate advanced collapse)/SNAC (scaphoid non-union advanced collapse) wrist arthritis. We report a case of ulnar-sided wrist pain which occurred after four-corner fusion for stage II SNAC wrist with a previously-asymptomatic ulnar positive variance, and was successfully treated by ulnar shortening osteotomy. This case highlights a possible coincidental pathology of the ulnocarpal joint in the setting of post-traumatic radiocarpal arthrosis.

scholarly journals Enterobacteriaceae isolates carrying the New Delhi metallo-β-lactamase gene in Yemen

2014 ◽  
Vol 63 (10) ◽  
pp. 1316-1323 ◽  
Author(s):  
Alima Gharout-Sait ◽  
Samer-Ahmed Alsharapy ◽  
Lucien Brasme ◽  
Abdelaziz Touati ◽  
Rachida Kermas ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Susceptibility Testing ◽  
Enterobacter Cloacae ◽  
New Delhi ◽  
Carbapenem Resistant ◽  
Genes Encoding ◽  
Phenotypic Tests ◽  
Lactamase Gene ◽  
Sequence Types

Ten carbapenem-resistant Enterobacteriaceae (eight Klebsiella pneumoniae isolates and two Enterobacter cloacae) isolates from Yemen were investigated using in vitro antimicrobial susceptibility testing, phenotypic carbapenemase detection, multilocus sequence typing (MLST) and replicon typing. Carbapenemase, extended-spectrum β-lactamase (ESBL) and plasmid-mediated quinolone resistance determinant genes were identified using PCR and sequencing. All of the 10 carbapenem-resistant Enterobacteriaceae were resistant to β-lactams, tobramycin, ciprofloxacin and cotrimoxazole. Imipenem, doripenem and meropenem MICs ranged from 2 to >32 mg l−1 and ertapenem MICs ranged from 6 to >32 mg l−1. All of the K. pneumoniae isolates showed ESBL activity in phenotypic tests. Genes encoding bla NDM were detected in all strains. All K. pneumoniae strains produced CTX-M-15 ESBL and SHV β-lactamases. TEM-1 β-lactamase was detected in seven isolates. Nine isolates were qnr positive including QnrB1, QnrA1 and QnrS1, and six isolates produced AAC-6′-Ib-cr. MLST identified five different sequence types (STs): ST1399, ST147, ST29, ST405 and ST340. Replicon typing showed the presence of IncFII1K plasmids in four transformants. To the best of our knowledge, this is the first report of NDM-1-producing Enterobacteriaceae isolates in Yemen.

scholarly journals Neurogenesis and Oligodendrogenesis in a Mouse Model of Blast-Induced Traumatic Brain Injury

2020 ◽  
pp. 1-14
Author(s):  
Michal K. Stachowiak ◽  
D. Freedman ◽  
N. Nived ◽  
B. Decker ◽  
S. Narla ◽  
...  
Keyword(s):  
Brain Injury ◽  
Brain Function ◽  
Brain Cortex ◽  
Post Traumatic Stress ◽  
Model Following ◽  
Initial Injury ◽  
Initial Activation ◽  
Post Traumatic ◽  
Oligodendrocyte Precursor ◽  
The Brain

Neurological manifestations of blast-induced Post Traumatic Stress Disorder (PTSD) extend long after the initial injury indicating lasting changes in brain function. In this study, we characterized brain injury, changes in neurogenesis and oligodendrogenesis in an adult murine blast model following a short (5 days) and long (21 days) post-blast recovery. Acoustic blasts led to an initial, activation of microglia and astrogliosis and a widespread cortical and subcortical apoptosis. The loss of myelinated cortical axons at 5 days was followed by the reappearance of abnormal misdirected fibers at 21 days. At 21 days post-blast, we observed increases in doublecortin-positive (DCX+ ) neuroblasts in the subventricular zone (SVZ) and hippocampal subgranular zone (SGZ) indicating increased neurogenesis. No changes in DCX+ cells were found in the brain cortex. In the cortex, the early disappearance of myelinated neuronal fibers was accompanied by a loss of O4+ oligodendrocytes and their Ki67-expreasing (Ki67+ ) oligodendrocyte precursor cells (OPC). However, at 5 days we observed a robust appearance of cells expressing Olig2 (O2+ ), an early determinant of oligodendrocyte lineage. At 21 days post-blast, the population of OPC increased and the mature O4+ oligodendrocytes were restored to control levels. In contrast, in the SVZ and SGZ, O4+ cells were not affected by the blast suggesting a local cortical origin for cortical oligodendrogenesis. These results suggest that blast-induced activation of SVZ and SGZ neurogenesis and cortical oligodendrogenesis could have long-lasting impact on brain function including memory disorders observed in both animal models and human’s PTSD.

scholarly journals Clinical outcome of operative treatment in 18 cases of giant cell tumors of bones

2020 ◽  
Vol 10 (2) ◽  
pp. 67-71
Author(s):  
Suresh Pandey
Keyword(s):  
Clinical Outcome ◽  
Giant Cell ◽  
De Novo ◽  
Excellent Result ◽  
Giant Cell Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Non Union ◽  
Proximal Fibula

Background: Giant Cell Tumor of the bone (GCTB) has got variable outcome after the different methods of surgical treatment depending upon the site and grade of lesion and extent of tumor removal. This retrospective prospective analysis of operatively treated cases of GCTB of different sites aimed to highlight the clinical outcome. Methods: This was a prospective observational study of 18 cases of GCTB; proximal tibia (n=6), distal femur (n=5), distal radius (n=4), proximal femur (n=1), proximal fibula (n=1) and anterior arc of first rib (n=1) treated with different operative management with mean follow up of 53.61 months. Functional outcome with Musculoskeletal Tumor Society Score (MSTS), recurrence and complications were analyzed with at least 24 months of follow up. Results: There were 10 females and 8 males with average age at presentation 27.3 years (range 15-38). Average duration of symptom was 4.72 months. 2 were cases of recurrence previously op­erated and 16 were de novo cases. Mean MSTS was 84.27% with good to excellent result in 88%. There were no non-union, graft failure, metastasis, prosthetic failure or wound infection till at least 24 months of follow up in any of the cases. Conclusions: Extended curettage or reconstruction with auto graft in grade I and II tumor or en­doprosthesis in higher grade or recurrence of GCTB can give good to excellent functional result in majority of the cases.

scholarly journals Molecular Characterization of Carbapenem-Resistant Enterobacter cloacae in 11 Chinese Cities

2018 ◽  
Vol 9 ◽  
Author(s):  
Chunmei Jin ◽  
Jiangang Zhang ◽  
Qi Wang ◽  
Hongbin Chen ◽  
Xiaojuan Wang ◽  
...  
Keyword(s):  
Molecular Characterization ◽  
Enterobacter Cloacae ◽  
Chinese Cities ◽  
Carbapenem Resistant

scholarly journals In Vitro Antibacterial Activity and Mechanism of Vanillic Acid against Carbapenem-Resistant Enterobacter cloacae

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 220 ◽  
Author(s):  
Weidong Qian ◽  
Yuting Fu ◽  
Miao Liu ◽  
Ting Wang ◽  
Jianing Zhang ◽  
...  
Keyword(s):  
Antibacterial Activity ◽  
Membrane Potential ◽  
Cell Membrane ◽  
Crystal Violet ◽  
Vanillic Acid ◽  
Membrane Integrity ◽  
Enterobacter Cloacae ◽  
Carbapenem Resistant ◽  
Atp Concentration

Vanillic acid (VA) is a flavoring agent found in edible plants and fruits. Few recent studies exhibited robust antibacterial activity of VA against several pathogen microorganisms. However, little was reported about the effect of VA on carbapenem-resistant Enterobacter cloacae (CREC). The purpose of the current study was to assess in vitro antimicrobial and antibiofilm activities of VA against CREC. Here, minimum inhibitory concentrations (MIC) of VA against CREC was determined via gradient diffusion method. Furthermore, the antibacterial mode of VA against CREC was elucidated by measuring changes in intracellular adenosine triphosphate (ATP) concentration, intracellular pH (pHin), cell membrane potential and membrane integrity. In addition, antibiofilm formation of VA was measured by crystal violet assay and visualized with field emission scanning electron microscopy (FESEM) and confocal laser scanning microscopy (CLSM). The results showed that MIC of VA against E. cloacae was 600 μg/mL. VA was capable of inhibiting the growth of CREC and destroying the cell membrane integrity of CREC, as confirmed by the decrease of intracellular ATP concentration, pHin and membrane potential as well as distinctive variation in cellular morphology. Moreover, crystal violet staining, FESEM and CLSM results indicated that VA displayed robust inhibitory effects on biofilm formation of CREC and inactivated biofilm-related CREC cells. These findings revealed that VA exhibits potent antibacterial activity against CREC, and thus has potential to be exploited as a natural preservative to control the CREC associated infections.

Antimicrobial and Antibiofilm Activities of Citral Against Carbapenem-Resistant Enterobacter cloacae

2020 ◽  
Vol 17 (7) ◽  
pp. 459-465 ◽  
Author(s):  
Weidong Qian ◽  
Miao Liu ◽  
Yuting Fu ◽  
Ting Wang ◽  
Jianing Zhang ◽  
...  
Keyword(s):  
Enterobacter Cloacae ◽  
Carbapenem Resistant
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