scholarly journals Discarded old antibiotics as a new arsenal for multi-resistant isolates in diabetic foot ulcer infections: Therapeutic value of parenteral Colistin versus multi-resistant Pseudomonas speciesisolate strains. Case Report

2021 ◽  
Author(s):  
Ahmed Shabhay ◽  
Jaffu O. Chilongola ◽  
Stephen Mshana ◽  
Zarina Shabhay ◽  
Jeff Van Baal ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Renal Impairment ◽  
Lower Limb ◽  
Main Pulmonary Artery ◽  
Lower Lobe ◽  
Lower Limbs ◽  
Carbapenem Resistant ◽  
Left Lower Limb ◽  
Resistant Strains ◽  
Novel Antibiotics

Abstract Background Antimicrobial resistance to current novel antibiotics is posing a major threat to both human and zoonotic life. This poses a serious potential of rolling back to pre-antibiotic era clinical settings. Antimicrobial discovery pipeline has dried up as major pharmaceutical brands have shifted to long term chronic illness drugs production. In the absence of new novel antibiotics molecules, clinicians have resorted into a desperate last resort to review and re-introduce prior discarded antibiotics as their new weaponry in the fight against multi-resistant Gram-negative bacteria. Case presentation: We report a case of a 77 years old bed ridden diabetic and hypertensive with renal impairment diagnosed with bilateral lower limbs wet gangrene. She underwent transfemoral on her right and transtibial amputation on her left lower limb. She developed Surgical site infection on her right stump and wet gangrene on her left stump. Surgical toilet, debridement and stump revision was done on her right stump and a transfemoral amputation on her left lower limb. Pus swab on her right stump revealed carbapenem resistant strains of Pseudomonas aeruginosa. She was instituted on parenteral colistin and showed no bacterial growth 7 days post treatment. She suffered an ischaemic cerebral vaso-occlusive stroke during her hospital stay. CT angiography revealed distal infra-renal abdominal aorta multiple calcified plaques, multiple calcified plaques and completely obstructing thrombus both on common and external iliac arteries, seen downstream to both superficial femoral arteries with multiple collaterals in both thighs. The included portion of the lower lung fields showed a large filling defect in the right main pulmonary artery extending to the lower lobe branches suggestive of right-sided pulmonary embolism. She developed hypostatic pneumonia, bed sores and her condition deteriorated and she unfortunately succumbed from her comorbidities. Despite our patient succumbing to her multiple co-morbidities we report this case to highlight the isolation of carbapenem resistant strains of Pseudomonas aeruginosa and the efficacy and safety of colistin as a salvage antibiotic in renal impaired patients. Conclusions Colistin can be safely used as a last reserve antibiotic for multi-resistant strains of Pseudomonas aeruginosa infection even in patients with renal impairment.

scholarly journals Discarded old antibiotics as a new arsenal for multi-resistant isolates in diabetic foot ulcer infections: therapeutic value of parenteral colistin versus multi-resistant Pseudomonas species isolate strains: case report

2021 ◽  
Vol 10 (12) ◽  
pp. 1414
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Theresia Mwakyembe ◽  
Stephen E. Mshana ◽  
Zarina Shabhay ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Main Pulmonary Artery ◽  
Lower Lobe ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Filling Defect ◽  
Lower Limbs ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Novel Antibiotics

Antimicrobial resistance to current novel antibiotics is posing a major threat to both human and zoonotic life. In the absence of new novel antibiotics molecules, clinicians have resorted into a desperate last resort to review and re-introduce prior discarded antibiotics as their new weaponry in the fight against multi-resistant gram negative bacteria. We reported a case of a 77 year old bed ridden diabetic and hypertensive with renal impairment diagnosed with bilateral lower limbs wet gangrene. She underwent transfemoral on her right and transtibial amputation on her left lower limb. She developed surgical site infection on her right stump and wet gangrene on her left stump. Pus swab on her right stump revealed carbapenem resistant strains of Pseudomonas aeruginosa. She was instituted on parenteral colistin and showed no bacterial growth 7 days post treatment. She suffered an ischaemic cerebral vaso-occlusive stroke during her hospital stay. CT angiography of lower lung fields showed a large filling defect in the right main pulmonary artery extending to the lower lobe branches suggestive of right-sided pulmonary embolism. Our patient succumbed from her co-morbidities. Despite our patient succumbing to her multiple co-morbidities we reported this case to highlight the isolation of carbapenem resistant strains of P. aeruginosa and the efficacy and safety of colistin as a salvage antibiotic in renal impaired patients. Colistin can be safely used as a last reserve antibiotic for multi-resistant strains of P. aeruginosa infection even in patients with renal impairment.

scholarly journals Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India

2015 ◽  
Vol 9 (11) ◽  
pp. 1289-1293 ◽  
Author(s):  
Kavitha Saravu ◽  
Rajagopal Kadavigere ◽  
Ananthakrishna Barkur Shastry ◽  
Rohit Pai ◽  
Chiranjay Mukhopadhyay
Keyword(s):  
Lower Limb ◽  
Corticosteroid Treatment ◽  
Conus Medullaris ◽  
Subdural Empyema ◽  
Lower Limbs ◽  
High Dose ◽  
Limb Weakness ◽  
Subdural Collection ◽  
Lower Limb Weakness ◽  
Left Lower Limb

Two distinct and potentially deceitful cases of neurologic melioidosis are reported. Case 1: A 39-year-old alcoholic and uncontrolled diabetic male presented with cough, fever, and left focal seizures with secondary generalization. An magnetic resonance imaging (MRI) brain scan revealed a small peripherally enhancing subdural collection along the interhemispheric fissure suggestive of minimal subdural empyema. Blood culture grew Burkholderia pseudomallei. Patient was diagnosed with disseminated bacteraemic melioidosis with subdural empyema. He was successfully treated with ceftazidime-cotrimoxazole-doxycycline. Case 2: A 45-year-old male presented with left lower limb weakness, difficulty in passing urine and stool, and back pain radiating to lower limbs. Neurological examination revealed flaccid left lower limb with absent deep tendon reflexes and plantar reflex. Spinal MRI showed T2 hyperintensity from D9 to L1 suggestive of demyelination. Patient was treated with high dose methylprednisolone. By day 3 of steroid treatment, lower limb weakness progressed. Subsequent MRI showed extensive cord hyperintensity on T2 weighted sequence extending from C5 to conus medullaris consistent with demyelination. Cerebrospinal fluid (CSF) culture grew B. pseudomallei, and the patient was given meropenem-cotrimoxazole. After three weeks of parenteral treatment, the lower limbs remained paralyzed. Patient was discharged on oral cotrimoxazole-doxycycline. Conclusions: Melioidosis should be considered as a differential in focal suppurative central nervous system (CNS) lesions, meningoencephalitis, or encephalomyelitis in endemic areas. CNS infections must be ruled out prior to steroid administration. The role of corticosteroids in demyelinating CNS melioidosis has been refuted. This is a rare documentation of effect of unintentional corticosteroid treatment in melioidosis.

scholarly journals Spondylodiscitis and early diagnosis: a case report

2021 ◽  
Author(s):  
Mariana Moreira Soares de Sa ◽  
Emanuelle Ferreira Barreto ◽  
Marina Soares Vilela ◽  
Roberta Kelly Netto Vinte Guimarães ◽  
Vanessa Alves Lobato ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Early Diagnosis ◽  
Lower Limb ◽  
Clinical Case ◽  
Lower Limbs ◽  
Lumbosacral Spine ◽  
Low Back ◽  
Left Lower Limb

Context: Spondylodiscitis is a term that includes vertebral osteomyelitis, spondylitis and discitis. Among the vertebrae, the most affected are the lumbar (45%), followed by the thoracic (35%). Adults present themselves progressively, with a predominant complaint of low back pain and pain on palpation of the affected site, with significant limitation of movement due to muscle spasms. Report a clinical case with an emphasis on the possibility of early diagnosis and correct treatment aimed at the recovery of patients with neurological sequelae. Analysis of medical records in a patient admitted to the neurology ward of Santa Casa de Belo Horizonte. Clinical Case report: A.I.S. patient, 45 years old, with chronic low back pain due to asymmetry of the left lower limb. History of wear of the femoral head diagnosed in adolescence. Evolving for 2 months with progressive weakness in the lower limbs, associated with paresis and paresis in the left lower limb. He performed abdominal USG which showed hepatosplenomegaly with collateral circulation, increased caliber of the portal, splenic and superior mesenteric veins. Tomography of the lumbosacral spine with osteolytic lesions in the joints of L2-L3, L3-L4 and L4-L5., With almost total osteolysis of the L4 vertebral body, retropulsion of much later at this level, suggesting spondylodiscitis. The resonance of the lumbar spine performed with acute spondylodiscitis L2-L3 and L3-L4, compressing the roots of the equine tail with a comprehensive potential, remains as the emerging emerging roots. Liquid filling of the L3- L4 intervebral disc compatible with acute spondylodiscitis. Staphylococcus aureus and enterobacteria are responsible for more than half of the cases of non-tuberculosis. Conclusion: The diagnosis of discitis can be quite difficult, due to the rarity of the disease, the insidious symptoms and the high prevalence of low back pain in the general population. It is considered an important morbidity factor, as it causes an important neurological sequel. In addition, it points to the importance of differential diagnosis of low back pain in the population.

Klippel–Trénaunay Syndrome and Developmental Coxa Vara in the Same Limb: A Case Report with a Review of the Literature

2021 ◽  
Author(s):  
Balaji Zacharia ◽  
Jittu Alex ◽  
Ashwin Rajmohan
Keyword(s):  
Lower Limb ◽  
Lower Limbs ◽  
Coxa Vara ◽  
Port Wine ◽  
Review Of The Literature ◽  
Left Femur ◽  
Port Wine Stains ◽  
Left Lower Limb ◽  
Klippel Trenaunay Syndrome

AbstractWe present a case of a 14-year-old girl who was first treated when she was 4 years old. She had progressive limping of the left lower limb from the age of 3 years. She was diagnosed to have developmental coxa vara of the left hip and treated by a subtrochanteric valgus osteotomy of the left femur. Later, she developed hypertrophy of the left upper and lower limbs. There were port-wine stains over the left lower limbs with multiple superficial varicosities. Her diagnosis was Klippel–Trénaunay syndrome (KTS). She is asymptomatic at the final follow-up. Both developmental coxa vara and KTS are rare conditions. We present this case to demonstrate the rarest combination of two rare conditions occurring in the same limb.

An Extremely Rare Disconnection of the External Iliac Artery and Novel Collateral Remodeling in an Endometrial Stromal Sarcoma Woman

2021 ◽  
Author(s):  
Shixuan Wang ◽  
Ting Zhou ◽  
Nan Yu ◽  
Ronghua Liu
Keyword(s):  
Iliac Artery ◽  
Lower Limb ◽  
External Iliac Artery ◽  
Endometrial Stromal Sarcoma ◽  
Lessons Learned ◽  
Lower Limbs ◽  
Arterial Blood Flow ◽  
Stromal Sarcoma ◽  
Arterial Blood ◽  
Left Lower Limb

Abstract Background: Injury to the external iliac artery (EIA) can have serious consequences and can be extremely challenging for surgeons. Here, we report a patient with bizarre disconnection of the external iliac artery during a laparoscopic operation.Case presentation: On May 27, 2020, during a laparoscopic pelvic lymphadenectomy operation to treat endometrial stromal sarcoma, we encountered an unusual anatomy: abnormal disconnection of the left external iliac artery in a 26-year-old female patient. The proximal and distal ends of the left external iliac artery demonstrated old narrowing without active bleeding, and the distance between the two disconnected ends was more than 3 cm. The scenario was surprising to the entire staff in the operating theater. After a comprehensive assessment of skin temperature, arterial pulsation and arterial blood flow, a multidisciplinary team (MDT) determined that collateral circulation of the left lower limb had been established and could meet the blood supply of the lower limbs, which was also confirmed three times by computed tomography angiography (CTA) and Doppler ultrasound of the blood vessels in the abdomen and lower limbs. Eleven months after the operation, the patient had no obvious abnormality, and the daily activities of the left lower limb were not affected. Follow-up after treatment for the patient is still in progress.Conclusions: We describe the details of the whole case of disconnection of the external iliac artery. We hope to summarize the experience and lessons learned through this case and a relevant literature review to improve the safety and orderliness of our future clinical work.

scholarly journals Occurrence of Polymelia in a Female Child

2013 ◽  
Vol 3 ◽  
pp. 18 ◽  
Author(s):  
Satyajeet Verma ◽  
Manish Khanna ◽  
V. N. Tripathi ◽  
N. C. Yadav
Keyword(s):  
Lower Limb ◽  
Rare Case ◽  
Female Child ◽  
Lower Limbs ◽  
Left Lower Limb

We report a rare case of polymelia in a 6-month-old female child who presented with developed lower limbs and an additional underdeveloped left lower limb.

Pseudomonas aeruginosa at the dawn of a post-antibiotic era: clinical significance, resistance mechanisms, novel antibiotics and alternative treatments

2020 ◽  
Vol 65 (2) ◽  
pp. 31-67
Author(s):  
Orsolya Kovács ◽  
Endre Jakab
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Treatment Options ◽  
Opportunistic Pathogen ◽  
Resistance Mechanisms ◽  
Modern Medicine ◽  
Host Cells ◽  
Bacteriophage Therapy ◽  
Priority List ◽  
Resistant Strains ◽  
Novel Antibiotics

Since their discovery, antibiotics have helped treat diseases prior to which many were untreatable, saving millions of lives. However, due to the overuse of antibiotics in medicine and agriculture, the advent of resistant strains of bacteria followed shortly after. The current antibiotic resistance crisis is bringing humanity closer to a post-antibiotic era, when all the advancements made by modern medicine could easily be reversed. Pseudomonas aeruginosa is a Gram-negative, rod-shaped bacterium, ubiquitous owing to its minimal nutritional and growth requirements. P. aeruginosa is one of the pathogens included in the priority list of the WHO, being assessed as critical due to its high antimicrobial resistance, leaving only a few effective treatment options to combat it. As an opportunistic pathogen, P. aeruginosa establishes infection in immunocompromised patients, primarily in hospital settings. In order to initiate infection, it requires several virulence factors that mediate the invasion of the pathogen into host cells. Owing to the multiple resistance mechanisms of P. aeruginosa, it has developed resistance to most classes of antibiotics. Due to its increased resistance, treating P. aeruginosa infections is a great challenge for clinicians. Several β-lactam/β-lactamase combinations have been approved and are available as treatment options, which overall show high efficacy against P. aeruginosa. Moreover, novel antibiotics are currently in development as possible antipseudomonal agents, including a Pseudomonas-specific formulation. In addition, new strategies such as bacteriophage therapy, pyocins or the inhibition of the quorum sensing system are being investigated for the treatment of P. aeruginosa infections.

scholarly journals Characteristics of Carbapenem-Resistant Pseudomonas aeruginosa Strains in Patients with Ventilator-Associated Pneumonia in Intensive Care Units

Medicina ◽  
2012 ◽  
Vol 47 (12) ◽  
pp. 95
Author(s):  
Astra Vitkauskienė ◽  
Erika Skrodenienė ◽  
Asta Dambrauskienė ◽  
Giedrė Bakšytė ◽  
Andrius Macas ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Intensive Care Units ◽  
University Hospital ◽  
Test Results ◽  
Disk Diffusion Test ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
High Level ◽  
O 11

The aim of this study was to determine the characteristics of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) strains and 5-year changes in resistance in a tertiary university hospital. Material and Methods. The study included 90 and 101 randomly selected P. aeruginosa strains serotyped in 2003 and 2008, respectively. The standardized disk diffusion test and E-test were used to determine resistance to antibiotics. P. aeruginosa strains were considered to have high-level resistance if a minimum inhibitory concentration (MIC) for imipenem or meropenem was >32 μg/mL. To identify serogroups, sera containing specific antibodies against O group antigens of P. aeruginosa were used. P. aeruginosa isolates resistant to imipenem or/and meropenem were screened for metallo-β-lactamase (MBL) production by using the MBL E-test. Results. Comparison of the changes in resistance of P. aeruginosa strains to carbapenems within the 5-year period revealed that the level of resistance to imipenem increased. In 2003, 53.3% of P. aeruginosa strains were found to be highly resistant to imipenem, while in 2008, this percentage increased to 87.8% (P=0.01). The prevalence of MBL-producing strains increased from 15.8% in 2003 to 61.9% in 2008 (P<0.001). In 2003 and 2008, carbapenem-resistant P. aeruginosa strains were more often resistant to ciprofloxacin and gentamicin than carbapenem-sensitive strains. In 2008, carbapenem- resistant strains additionally were more often resistant to ceftazidime, cefepime, aztreonam, piperacillin, and amikacin than carbapenem-sensitive strains. MBL-producing P. aeruginosa strains belonged more often to the O:11 serogroup than MBL-non-producing strains (51.7% vs. 34.3%, P<0.05). A greater percentage of non-MBL-producing strains had low MICs against ciprofloxacin and amikacin as compared with MBL-producing strains. Conclusions. The results of our study emphasize the need to restrict the spread of O:11 serogroup P. aeruginosa strains and usage of carbapenems to treat infections with P. aeruginosa in the intensive care units of our hospital

Biofilm formation and serum susceptibility in Pseudomonas aeruginosa

Open Medicine ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Greta Mikucionyte ◽  
Asta Dambrauskiene ◽  
Erika Skrodeniene ◽  
Astra Vitkauskiene
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Respiratory Tract ◽  
Biofilm Formation ◽  
Clinical Samples ◽  
Opportunistic Pathogens ◽  
Carbapenem Resistant ◽  
Biofilm Production ◽  
Significant Difference ◽  
Resistant Strains ◽  
Different Sources

AbstractPseudomonas aeruginosa (P. aeruginosa) is one of the most important opportunistic pathogens. The pathogenicity of P. aeruginosa has been associated with multiple bacterial virulence factors. The aim of this study was to evaluate the association between P. aeruginosa strains obtained from various clinical samples and resistance to antibiotics and pathogenicity factors, such as resistance to serum bactericidal activity and biofilm formation. This study included 121 P. aeruginosa strains isolated from clinical samples; 65 of the isolated P. aeruginosa strains were carbapenem-resistant, and 56 were carbapenem-sensitive. Carbapenem-resistant P. aeruginosa strains were more often resistant to the majority of tested antibiotics, compared to carbapenem-sensitive strains. We did not find any statistically significant difference between resistance to carbapenems and serum resistance and ability of tested P. aeruginosa strains to produce biofilms. Carbapenem-resistant P. aeruginosa strains were recovered from the urinary tract significantly more often (75.0%) than carbapenem-sensitive P. aeruginosa strains (25.0%). Carbapenem-sensitive P. aeruginosa strains were recovered significantly more often from the respiratory tract than carbapenem-resistant strains, 60.0% and 40.0%, respectively. All the P. aeruginosa strains recovered from blood were serum-resistant. P. aeruginosa strains recovered from the respiratory tract and wounds were significantly frequently serum sensitive, 95.6% and 56.6%, respectively. We did not find any differences in biofilm production among the P. aeruginosa strains recovered from different sources.

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