scholarly journals Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

2020 ◽  
Author(s):  
Sang Ho Kwak ◽  
Jung Yun Bae ◽  
Youngkwang Oh ◽  
Hyo Seok Jang ◽  
Tae Young Ahn ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Treatment Plan ◽  
Case Series ◽  
Flap Surgery ◽  
Surgical History ◽  
History Of ◽  
Retrospective Comparative Study

Abstract BackgroundSeptic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare.MethodsIn this retrospective review of consecutive case series, 45 patients (primary, n=11; referred, n=34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. ResultsIn the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients.ConclusionsThis study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

scholarly journals Primarily treated patients versus referred patients in the treatment of native septic arthritis of digits: a retrospective comparative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Ho Kwak ◽  
Jung Yun Bae ◽  
Youngkwang Oh ◽  
Hyo Seok Jang ◽  
Tae Young Ahn ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Treatment Plan ◽  
Case Series ◽  
Flap Surgery ◽  
Surgical History ◽  
History Of ◽  
Retrospective Comparative Study

Abstract Background Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. Methods In this retrospective review of consecutive case series, 45 patients (primary, n = 11; referred, n = 34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. Results In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients. Conclusions This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

scholarly journals Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

2020 ◽  
Author(s):  
Sang Ho Kwak ◽  
Jung Yun Bae ◽  
Youngkwang Oh ◽  
Hyo Seok Jang ◽  
Tae Young Ahn ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Treatment Plan ◽  
Case Series ◽  
Flap Surgery ◽  
Surgical History ◽  
History Of ◽  
Retrospective Comparative Study

Abstract Background Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. Methods In this retrospective review of consecutive case series, 45 patients (primary, n=11; referred, n=34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. Results In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients.Conclusions This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

scholarly journals Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

2020 ◽  
Author(s):  
Sang Ho Kwak ◽  
Jung Yun Bae ◽  
Youngkwang Oh ◽  
Hyo Seok Jang ◽  
Tae Young Ahn ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Treatment Plan ◽  
Case Series ◽  
Flap Surgery ◽  
Surgical History ◽  
History Of ◽  
Retrospective Comparative Study

Abstract Background Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. Methods In this retrospective review of consecutive case series, 45 patients (primary, n =11; referred, n =34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. Results In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients. Conclusions This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

scholarly journals Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

2020 ◽  
Author(s):  
Sang Ho Kwak ◽  
Jung Yun Bae ◽  
Youngkwang Oh ◽  
Hyo Seok Jang ◽  
Tae Young Ahn ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Treatment Plan ◽  
Case Series ◽  
Flap Surgery ◽  
Surgical History ◽  
History Of ◽  
Retrospective Comparative Study

Abstract Background Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. Methods In this retrospective review of consecutive case series, 45 patients (primary, n=11; referred, n=34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. Results In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients.Conclusions This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

scholarly journals Case Study: Pneumococcal Prosthetic Valve Endocarditis with Mitral Annular Abscess Fistulised in the Left Atrium: An Uncommon Germ with Dramatic End

2021 ◽  
Vol 07 (06) ◽  
Author(s):  
S. Hilal ◽  
Keyword(s):  
Antibiotic Therapy ◽  
Left Atrium ◽  
High Mortality ◽  
Prosthetic Valve ◽  
Case Series ◽  
Prosthetic Valve Endocarditis ◽  
History Of ◽  
Efficient Care ◽  
Annular Abscess

Background: Streptococcus pneumoniae is an infrequent cause of infectious endocarditis. Several case series have underscored the aggressive course of Streptocoque Pneumiae with acute clinical presentation, rapid valvular destruction, and high mortality despite appropriate antibiotic therapy. Case summary: We present a 74-year-old woman with previous aortic and mitral valve replacement 12 years ago, presented with a 5 days history of persistent fever and a red, hot, and swollen right knee. Atrial fibrillation was demonstrated on a 12-lead electrocardiogram. The initial echocardiography did not show any sign of endocarditis but in front of the clinical symptomatology the patient was put under probabilistic antibiotic therapy. in the meantime blood culture grew Streptocoque Pneumiae and then the antibiotic treatment was adapted. The sudden deterioration of the patient brought us back to control the heart by a transthoracic echocardiography, which revealed a mitral annular abscess fistulizing to the left atrium. the patient expired 30 days after admission from presumed severe sepsis and cardiogenic choc. Conclusion: Pneumococcal endocarditis in prosthetic valve is associated with very high mortality, especially when complicated by paravalvular abscess and other comorbidities. This case highlights the need for a carefull considered approach for fast and efficient care.

Novel Approach for 2-Port Laparoscopic Hysterectomy

2019 ◽  
Vol 26 (4) ◽  
pp. 442-448
Author(s):  
Paul Tyan ◽  
James Robinson ◽  
Monica Dandapani ◽  
Jessica Li ◽  
Alex Gu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Case Series ◽  
Laparoscopic Hysterectomy ◽  
University Hospital ◽  
Surgical Interventions ◽  
Novel Approach ◽  
Estimated Blood Loss ◽  
Surgical History ◽  
Retrospective Comparative Study

Background and Objectives. To describe a novel technique for a port-reducing laparoscopic hysterectomy. The 2-port laparoscopic hysterectomy (TPH) is performed through two 5-mm ports without the use of any multiport channels. We demonstrate outcomes via a large case series. We also describe and provide a video showing the TPH technique. Methods. Retrospective comparative study between the newly developed TPH and the conventional 4-port hysterectomy techniques. Variables of patients who underwent a TPH with fellowship-trained gynecologic surgeons at a single academic university hospital were collected through electronic medical records chart review. Results. Forty-five patients underwent a TPH. Mean age was 39.4, body mass index was 28.5 kg/m2, and uterine weight was 170.0 g. Our outcomes of interest were operative time (98.4 minutes, mean), estimated blood loss (65.6 mL, mean), conversion to 3-port (1/45), and intraoperative (0/45) and postoperative (5/45) complications. By comparing the TPH to the conventional 4-port laparoscopic hysterectomy within a similar setting, we provide insight into variables that prompt the minimally invasive gynecologic surgeon to perform a port-reducing procedure. Patients were more likely to be allocated for a TPH if they were younger (37.8 vs 44.7, P = .005), had a lower body mass index (29.0 vs 32.5, P = .07), smaller uterus (143.1 vs 672.3 g, P < .001), and were white (56.8% and 22.4%, P < .001). Conclusions. The TPH is a novel port-reducing hysterectomy that is safe in a subset of patients with small uteri and limited surgical history who require no other surgical interventions at the time of hysterectomy.

scholarly journals A case series on necrotising fasciitis of breast: a rare but debilitating disease

2021 ◽  
Vol 8 (11) ◽  
pp. 3426
Author(s):  
S. P. Gayathre ◽  
Kudiyarasu M. ◽  
Bala Brindha S. ◽  
R. Kannan
Keyword(s):  
Risk Factor ◽  
Rare Disease ◽  
Surgical Procedure ◽  
Surgical Intervention ◽  
Immunocompromised Patient ◽  
Age Groups ◽  
Case Series ◽  
Necrotising Fasciitis ◽  
Lactating Mothers ◽  
History Of

Necrotising fasciitis of breast being a rare disease has only a meagre number of cases being reported and most commonly seen following trauma or surgical procedure to the breast. The reported cases have shown a predilection for lactating mothers with a history of surgical intervention to breast. This case series included 3 cases of necrotising fasciitis with varied etiologies in various age groups including a lactating mother, an immunocompromised patient and another patient with no other risk factor such as trauma or surgical intervention to breast and the subsequent difference in extent of surgical intervention and management in these patients. Extensive surgical debridement at the earliest was the mainstay of treatment in all three cases.

Acute Appendicitis

2017 ◽  
Author(s):  
Michael P. Catanzaro ◽  
Rachel J. Kwon
Keyword(s):  
Acute Appendicitis ◽  
Study Design ◽  
Observational Studies ◽  
Surgical Intervention ◽  
Case Series ◽  
Historical Study ◽  
Evidence Based ◽  
Broad Spectrum Antibiotic ◽  
History Of ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in surgery involving management and treatment of acute appendicitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: observational studies in study design. Reginald H. Fitz’s insights over a century ago in a seminal case series regarding the nature of appendicitis, its potential sequelae, and the value of urgent surgical intervention changed the disease from a deadly one into one that can be easily cured by surgery. However, with the advent of modern broad spectrum antibiotic therapy, Fitz’s assertion that immediate surgical therapy is always mandated has recently come under question.

scholarly journals Septic arthritis of the acromioclavicular joint: a case series and review of the literature

2018 ◽  
Vol 12 (4) ◽  
pp. 272-283
Author(s):  
Raymond G Steinmetz ◽  
Jeremiah J Maupin ◽  
Joel N Smith ◽  
Christopher B White
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Acromioclavicular Joint ◽  
English Literature ◽  
Effective Means ◽  
Case Series ◽  
Rare Condition ◽  
Surgical Debridement ◽  
Review Of The Literature ◽  
High Index Of Suspicion

Objective To report a case series of three patients with septic arthritis of the acromioclavicular joint and a review of the literature for this condition. Additionally, we developed an algorithm for diagnosing and treating septic arthritis of the acromioclavicular joint. Methods A retrospective review of patients treated at our institution for septic arthritis of the acromioclavicular joint during the collection period was performed and three cases were identified. A review of the English literature on this rare condition was also performed with only 28 cases being identified. Results A series of three consecutive patients were treated for septic acromioclavicular arthritis with resolution of the infection. Two patients underwent open surgical debridement and one underwent aspiration. All patients were treated with a minimum of six weeks of tailored intravenous antibiotic therapy. Conclusion Septic arthritis of the acromioclavicular joint can be difficult to diagnose and requires a high index of suspicion. Surgical debridement, open or arthroscopic, with tailored antibiotic therapy is an effective means for the management of septic arthritis of the acromioclavicular joint. In patients who are unable to have surgical debridement, aspiration and tailored antibiotics have been shown to be effective.

scholarly journals 1448. Prostate Abscess: Clinical Features, Management, and Outcomes of a “Stealth” Infection: A Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S528-S529
Author(s):  
Margaux E Wooster ◽  
Glen Huang ◽  
John W Sanders ◽  
James E Peacock
Keyword(s):  
Antibiotic Therapy ◽  
Median Duration ◽  
Case Series ◽  
Prior History ◽  
Abscess Drainage ◽  
Presenting Symptoms ◽  
Acute Prostatitis ◽  
All Cause Mortality ◽  
History Of ◽  
Comorbidity Index

Abstract Background Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause. Methods A retrospective review of all adult patients admitted with an ICD-9 or -10 diagnosis of PA between January 2013 and July 2018 was conducted. Inclusion criteria included age ≥18 years, a compatible GU infection syndrome, and imaging consistent with PA. Results Twenty-two patients with PA were identified. The median age was 57 years. Five patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. The median Charlson Comorbidity Index was 2. No patient had a prior history of PA but 3 patients had a past diagnosis of prostatitis. Only 1 patient had GU instrumentation in the preceding 6 weeks and no patient had an indwelling urethral catheter. Fever (59%), dysuria (49%), and urinary retention (32%) were the most common presenting symptoms. Only 7/18 (39%) patients had a tender prostate on examination; fluctuance was not described. Pelvic CT revealed PAs in all patients; 14 (64%) were solitary and 16 (73%) were >2 cm in greatest diameter. The median abscess size was 3.2 cm. Urine cultures were positive in 11/18 (61%) patients with 6/11 (55%) growing S. aureus (MRSA 3); 9/16 (56%) patients had positive blood cultures (S. aureus 7 with MRSA 3) and 5/5 had positive PA cultures (S. aureus 1). Nine patients (41%) were managed with antibiotics alone whereas 13 (59%) underwent abscess drainage. The median duration of antibiotic therapy was 34.5 days. All-cause mortality at 4 weeks was 9.1%. No relapses were documented at 6 months. When comparing patients with S. aureus PA to those with other causes, S. aureus patients more often had diabetes (86% vs. 33%, P = 0.06) and a longer median duration of antibiotic therapy (35 days vs. 31 days, P = 0.04) but age, abscess size, and mortality did not differ between groups. Conclusion PA is relatively uncommon and may be difficult to distinguish clinically from acute prostatitis. CT is critical to an accurate diagnosis. Optimal management usually requires both antibiotics and drainage. Given the frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA. Disclosures All authors: No reported disclosures.

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