scholarly journals The importance of early management of severe biliary infection: current concepts

2021 ◽  
Author(s):  
Mireia Amillo-Zaragueta ◽  
Esther Nve ◽  
Daniel Casanova ◽  
Pau Garro ◽  
Josep M Badia
Keyword(s):  
Clinical Presentation ◽  
Multidrug Resistant ◽  
Progressive Increase ◽  
Source Control ◽  
Control Treatment ◽  
Resistant Bacteria ◽  
Review Of The Literature ◽  
Early Management ◽  
Emergency Admissions ◽  
Intravenous Antibiotics

Background. The incidence of biliary infections is rising worldwide and has become one of the main reasons for emergency admissions. Methods. Narrative review of the literature emphasizing news concepts related to the early management of biliary diseases.  Results. The bacteriology is frequently polymicrobial, with a progressive increase of multidrug resistant bacteria. The form of presentation is variable, and the mortality rate may reach 20%. When cholecystitis or cholangitis is suspected, ultrasound is the gold standard imaging test. Depending on the severity of presentation, local resistances and risk factors for multi-resistant organisms, the most appropriate empirical antibiotic treatment must be initiated. In acute cholecystitis, cholecystectomy plays the main therapeutic role. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for source control. Treatment of severe cholangitis is based on the drainage of the bile duct and antibiotic therapy. Conclusions. Biliary infections are serious conditions which can lead to sepsis and death. The introduction of new internationally accepted guidelines, based on clinical presentation, laboratory tests and imaging, provides a platform for their timely diagnosis and management. Early severity assessment, initiation of intravenous antibiotics and source control are fundamental to improving morbidity and mortality.

scholarly journals P.031 A Rare Canadian Case of Cervical Pyomyosistis Presenting as Occipital Neuralgia

2021 ◽  
Vol 48 (s3) ◽  
pp. S29-S29
Author(s):  
H Girgis ◽  
M Ziller
Keyword(s):  
Source Control ◽  
Review Of The Literature ◽  
Computed Tomography Scan ◽  
Tropical Regions ◽  
Lower Limb Muscles ◽  
Nuchal Rigidity ◽  
Intravenous Antibiotics ◽  
Local Destruction ◽  
Immunocompromised Hosts ◽  
Tomography Scan

Background: Pyomyositis is an infectious disease usually encountered in tropical regions. It typically occurs in immunocompromised hosts and most commonly affects lower limb muscles. Our patient was a healthy Canadian with an atypical presentation of cervical pyomyositis. Methods: We report a case of a healthy 22-year old woman presenting to the emergency department with unprovoked severe bilateral cervico-occipital pain and nuchal rigidity. She remained afebrile. Review of the literature was conducted to search for similar presentations. Results: A Computed Tomography scan of the head and neck demonstrated the presence of a ring enhancing lesion in the semispinalis capitis muscle extending from the occiput to the C4 level. The abscess was surgically drained and cultures grew staphylococcus aureus. The patient rapidly improved on intravenous antibiotics. Literature review revealed this to be the first Canadian case of cervical pyomyositis. Conclusions: Cervical pyomyositis can be complicated by local destruction of the vertebrae, septic shock, endocarditis, septic emboli, brain abscess or rhabdomyolysis. Early diagnosis and source control is necessary to reduce the risk of morbidity. Therefore, it is important to consider this rare disease in the differential diagnosis of cervicalgia even in healthy immunocompetent patients.

Antibiotic Resistance: What Is the Impact of Agricultural Uses of Antibiotics on Children’s Health?

PEDIATRICS ◽  
2003 ◽  
Vol 112 (Supplement_1) ◽  
pp. 253-258
Author(s):  
Katherine M. Shea
Keyword(s):  
Large Scale ◽  
Antimicrobial Agents ◽  
Multidrug Resistant ◽  
Human Medicine ◽  
Resistant Bacteria ◽  
Review Of The Literature ◽  
The Past ◽  
New Drug Development ◽  
The Impact ◽  
Lines Of Evidence

Antimicrobial resistance has reached crisis stage in human medicine. The rapid acceleration of multidrug-resistant bacteria in the past 2 decades has overtaken new drug development, and patients and clinicians are faced with the prospect of untreatable infections. Although much of the problem stems from overuse and misuse of antimicrobial agents in human medicine, large-scale use of antimicrobials in agriculture also contributes to the crisis. Agricultural uses of antibiotics produce environmental exposures in a variety of reservoirs, which select for resistant microbes and microbial genes. This article presents the major lines of evidence documenting the risks to human health of some of the agricultural uses of antimicrobials. A brief review of the microbiologic antecedents of resistance is followed by a discussion of agricultural uses of antimicrobials and a targeted review of the literature, which provides the background knowledge and evidence necessary for pediatricians and other clinicians to be informed and to advocate for judicious use of antimicrobials in all sectors.

scholarly journals Abdominal Candidiasis Is a Hidden Reservoir of Echinocandin Resistance

2014 ◽  
Vol 58 (12) ◽  
pp. 7601-7605 ◽  
Author(s):  
Ryan K. Shields ◽  
M. Hong Nguyen ◽  
Ellen G. Press ◽  
Cornelius J. Clancy
Keyword(s):  
Candida Albicans ◽  
Candida Glabrata ◽  
Multidrug Resistant ◽  
Source Control ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Content Type ◽  
Echinocandin Resistance ◽  
Abdominal Candidiasis

ABSTRACTFKSmutantCandidaisolates were recovered from 24% (6/25) of abdominal candidiasis patients exposed to echinocandin.Candida glabrata(29%) andCandida albicans(14%) mutants were identified. Multidrug-resistant bacteria were recovered from 83% ofFKSmutant infections. Mutations were associated with prolonged echinocandin exposure (P= 0.01), breakthrough infections (P= 0.03), and therapeutic failures despite source control interventions (100%). Abdominal candidiasis is a hidden reservoir for the emergence of echinocandin-resistantCandida.

scholarly journals Antimicrobial Activity Study of Chinese Medicine Madeng’ai

2021 ◽  
Author(s):  
Zhenrong Tang ◽  
Yannan Zhao ◽  
Zaiqi Zhang ◽  
Huan Yue ◽  
Dan Wang ◽  
...  
Keyword(s):  
Antimicrobial Activity ◽  
Chinese Medicine ◽  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Control Treatment ◽  
Resistant Bacteria ◽  
Mice Model ◽  
Bacteria Growth

Abstract Background Due to the overuse of antibiotics, many multidrug-resistant bacteria have emerged, which brings huge challenges to the clinical treatment of bacterial infections. New products for anti-infection are necessary. Methods Madeng’ai powder was added with Milli-Q water or LB culture and autoclaved to prepare medicine suspension at different concentration. Bacteria were cultured in LB with different concentration of Madeng’ai. and swab on LB agar plates to get minimal inhibitory concentration (MIC) of Madeng’ai. Mice back was cut to make wound and MRSA/PAE suspension was injected in the wound area. Then swab with Madeng’ai extracts. Bacteria growth of infected secretions was checked on LB agar, and Hematoxylin and eosin (H&E) staining was performed for Histological analysis of skin tissues infected with bacteria after Madeng’ai and PBS (control) treatment. Results Madeng’ai could widely inhibit E.faecalis, Pseudomonas aeruginosa (PAE), Klebsiella pneumoniae (K.pneumoniae) and Acinetobacter baumannii (A.baumannii) at concentration of 4.0 mg/ml. The mice model also showed that Madeng’ai had imposed restrictions on MRSA and PAE growth in vivo. Conclusion Here, we report that a new Chinese medicine Madeng’ai has antimicrobial activity functions in vitro and in vivo. These data briefly showed that Madeng’ai functioned on antimicrobial and provided a new consideration for an antibiosis product.

scholarly journals Antimicrobial Treatment Duration in Sepsis and Serious Infections

2020 ◽  
Vol 222 (Supplement_2) ◽  
pp. S142-S155 ◽  
Author(s):  
Lindsay M Busch ◽  
Sameer S Kadri
Keyword(s):  
De Novo ◽  
Early Recognition ◽  
Clinical Effectiveness ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Source Control ◽  
Control Treatment ◽  
High Risk Population ◽  
Clinical Indicators ◽  
Clostridioides Difficile

Abstract Sepsis mortality has improved following advancements in early recognition and standardized management, including emphasis on early administration of appropriate antimicrobials. However, guidance regarding antimicrobial duration in sepsis is surprisingly limited. Decreased antibiotic exposure is associated with lower rates of de novo resistance development, Clostridioides difficile-associated disease, antibiotic-related toxicities, and health care costs. Consequently, data weighing safety versus adequacy of shorter treatment durations in sepsis would be beneficial. We provide a narrative review of evidence to guide antibiotic duration in sepsis. Evidence is significantly limited by noninferiority trial designs and exclusion of critically ill patients in many trials. Potential challenges to shorter antimicrobial duration in sepsis include inadequate source control, treatment of multidrug-resistant organisms, and pharmacokinetic alterations that predispose to inadequate antimicrobial levels. Additional studies specifically targeting patients with clinical indicators of sepsis are needed to guide measures to safely reduce antimicrobial exposure in this high-risk population while preserving clinical effectiveness.

scholarly journals Characterization of diarrheagenic Escherichia coli strains associated with diarrhea in children, Khouzestan, Iran

2018 ◽  
Vol 12 (08) ◽  
pp. 649-656 ◽  
Author(s):  
Sanaz Mahdavi Broujerdi ◽  
Mohammad Roayaei Ardakani ◽  
Seyedeh Elham Rezatofighi
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistant ◽  
Progressive Increase ◽  
Etiologic Agent ◽  
Phylogenetic Group ◽  
Resistant Bacteria ◽  
Phylogenetic Groups ◽  
E Coli ◽  
Diarrheagenic Escherichia Coli ◽  
Extended Spectrum Beta Lactamases

Introduction: Diarrheagenic Escherichia coli (DEC) is a major etiologic agent among the pathogens that cause diarrhea in children. Methodology: To investigate the presence and pathotypes of DEC in children under five years of age, living in the province of Khouzestan, Iran. 208 diarrhea stool samples were screened by multiplex-PCR. The isolated DEC isolates were investigated for resistance to various antimicrobials including the production of extended-spectrum beta-lactamases (ESBLs) and phylogenetic groups were determined. Results: DEC isolates were identified in 54 (26%) diarrhea samples, and 4 (7%) cases contained two DEC pathotypes. DEC isolated included 35 (16.8%) enteroaggregative E. coli (EAEC), ten (4.8%) enteropathogenic E. coli (EPEC), six (2.9%) enteroinvasive E. coli (EIEC), six (2.9%) enterotoxigenic E. coli (ETEC) and one (0.48%) LEE-positive EAEC. Shiga-toxin producing E. coli (STEC) was not identified in any diarrheal samples. The most prevalent resistance was observed with ceftazidime (88%), followed by ceftizoxime (83%) and ceftriaxone (71%). The majority of isolates (> 75%) were sensitive to Imipenem, ciprofloxacin, and amikacin. More than 65% of the pathogenic isolates showed a multidrug-resistant phenotype. ESBL-producing strains was observed in 79.3% of all DEC isolates. Phylogenetic group B2 was the most predominant group with a frequency of 44.8%. A significant association was observed between the B2 phylogenetic group and the DEC isolates (P < 0.05). Conclusions: Overall, our findings highlight the importance of the role of DEC isolates in the etiology of diarrhea in children in Iran. The progressive increase in antimicrobial resistance among DEC isolates makes it imperative to implement policies to control the spread of resistant bacteria.

Hydrocephalus in Spinal Muscular Atrophy: A Case Report and Review of the Literature

2020 ◽  
Author(s):  
Jeetendra P. Sah ◽  
Aaron W. Abrams ◽  
Geetha Chari ◽  
Craig Linden ◽  
Yaacov Anziska
Keyword(s):  
Spinal Muscular Atrophy ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Muscular Atrophy ◽  
Communicating Hydrocephalus ◽  
Type I ◽  
Review Of The Literature ◽  
Radiographic Findings ◽  
Comprehensive Review ◽  
The Relationship

AbstractIn this article, we reported a case of spinal muscular atrophy (SMA) type I noted to have tetraventricular hydrocephalus with Blake's pouch cyst at 8 months of age following intrathecal nusinersen therapy. The association of hydrocephalus with SMA is rarely reported in the literature. Development of hydrocephalus after intrathecal nusinersen therapy is also reported in some cases, but a cause–effect relationship is not yet established. The aim of this study was to describe the clinical characteristics of a patient with SMA type I and hydrocephalus, to review similar cases reported in the literature, and to explore the relationship between nusinersen therapy and development of hydrocephalus. The clinical presentation and radiographic findings of the patient are described and a comprehensive review of the literature was conducted. The adverse effect of communicating hydrocephalus related to nusinersen therapy is being reported and the authors suggest carefully monitoring for features of hydrocephalus developing during the course of nusinersen therapy.

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