Annals of The Royal College of Surgeons of England, 2014
We report the case of an eradicated multiresistant Serratia marcescens prosthetic hip joint infec... more We report the case of an eradicated multiresistant Serratia marcescens prosthetic hip joint infection. It is estimated that enteric Gram-negative organisms account for approximately 8% of prosthetic joint infections. However, the evolving multiresistant strains of organisms being encountered in hospital acquired infections is making eradication increasingly difficult. We describe n our surgical and microbiological approach to this in a complex case.
We describe a case of fatal lower limb necrotizing fasciitis in a 65-year-old man who was treated... more We describe a case of fatal lower limb necrotizing fasciitis in a 65-year-old man who was treated with broad-spectrum antibiotics, limb amputation and tissue debridement. The causative organism was identified by PCR as Haemophilus influenzae serotype f, which is a highly unusual cause of necrotizing fasciitis.
Blood culture contamination is a significant adverse event. This study evaluated whether using Ch... more Blood culture contamination is a significant adverse event. This study evaluated whether using ChloraPrep (2% alcoholic chlorhexidine) instead of 70% isopropyl alcohol wipes reduced contamination rates on two Medical Assessment Units (MAU1 and MAU2). ChloraPrep was introduced for 2 to 3-month intervention periods, initially on MAU1 and MAU2 and subsequently on MAU1 only. Contamination rates were compared with a matched time period in the preceding year and the three month period before ChloraPrep introduction. Education regarding venepucture technique was delivered. Contamination rates for the time matched pre-intervention period were 17.3% (51/295), MAU1 and 13.5% (31/230), MAU2. During the initial period of ChloraPrep use, rates declined (MAU1; 6.6% [P<0.001], MAU2; 8.5% [P=0.11] both Fisher's Exact Test). However, rates had already started to fall prior to ChloraPrep introduction. There was a non-significant difference between contamination rates in the comparator period immediately prior to ChloraPrep introduction and rates during the first intervention period (MAU1 and MAU2; P>0.05). During the second intervention period, absence of ChloraPrep on MAU2 did not significantly affect contamination (P=0.41) on this ward. ChloraPrep skin antisepsis did not give a significant reduction in blood culture contamination, but education may have led to the trend to lower contamination.
Abstract Infection with Vibrio vulnificus is uncommon in Europe but is associated with necrotisin... more Abstract Infection with Vibrio vulnificus is uncommon in Europe but is associated with necrotising wound infections and life-threatening septicaemia. This case is one of infection most likely to have been acquired from a thermal pool in Turkey without preceding ...
ABSTRACT We manage prosthetic joint infection without systemic antibiotics or prolonged hospital ... more ABSTRACT We manage prosthetic joint infection without systemic antibiotics or prolonged hospital admission (or intravenous antibiotics via outpatient intravenous services).1 We target antibiotic treatment to organisms isolated from either a diagnostic aspirate or joint washout (in the case of early infection). At the …
Figure 1 Intra-operative photograph during 1st stage showing radical soft tissue debridement and ... more Figure 1 Intra-operative photograph during 1st stage showing radical soft tissue debridement and excision of sinus. We read with interest the article by Cataldo et al. Here we report a recent case of prosthetic joint infection with an unusual organism treated successfully with minimal systemic antibiotics. A 75 year old male patient with a history of chronic lymphoid leukaemia (currently in remission) underwent a right total knee replacement for osteoarthritis at a district general hospital. Three weeks after discharge he was readmitted with a leaking wound and feeling unwell. He was subsequently taken to theatre for debridement and lavage of the right knee with retention of the prosthesis. Both fluid and one tissue sample from surgery grew Haemophilus Parainfluenzae, sensitive to amoxicillin and resistant to clarythromycin and tetracycline. The patient was treated with flucloxacillin and rifampicin for 6 weeks. Initially the patient’s general condition and knee improved. However, on stopping the antibiotics, he developed an abscess. This was aspirated and a Gram film revealed pus cells but no organisms were seen, nor subsequently cultured. The same antibiotic regime was then reinstated. One month later the patient was seen in our tertiary referral hospital by a consultant specialising in revision arthroplasty surgery. Examination revealed a discharging sinus in the proximal aspect of the wound and movements of the right knee were restricted. The CRP was 46 mg/L and ESR 82 mm/h. No organisms were cultured from a knee aspirate despite antibiotics having been stopped more than 2 weeks prior. A radical debridement with removal of the prosthesis (Fig. 1) was performed and tissue samples were sent to microbiology laboratory. The knee was stabilised with an intra-medullary rod which had been covered with antibiotic loaded bone cement. An additional 1 g of gentamicin and 2 g of vancomycin was added to each mix of Palacos cement (Heraeus Medical, Germany). Home made chains of antibiotic loaded beads with the same antibiotic combination were placed in the suprapatella pouch and both parapatellar gutters. The patient received standard prophylactic antibiotics which consisted of 3 doses of cefuroxime (750 mg). He received no further systemic antibiotics. His post operative recovery was uneventful.
Annals of The Royal College of Surgeons of England, 2014
We report the case of an eradicated multiresistant Serratia marcescens prosthetic hip joint infec... more We report the case of an eradicated multiresistant Serratia marcescens prosthetic hip joint infection. It is estimated that enteric Gram-negative organisms account for approximately 8% of prosthetic joint infections. However, the evolving multiresistant strains of organisms being encountered in hospital acquired infections is making eradication increasingly difficult. We describe n our surgical and microbiological approach to this in a complex case.
We describe a case of fatal lower limb necrotizing fasciitis in a 65-year-old man who was treated... more We describe a case of fatal lower limb necrotizing fasciitis in a 65-year-old man who was treated with broad-spectrum antibiotics, limb amputation and tissue debridement. The causative organism was identified by PCR as Haemophilus influenzae serotype f, which is a highly unusual cause of necrotizing fasciitis.
Blood culture contamination is a significant adverse event. This study evaluated whether using Ch... more Blood culture contamination is a significant adverse event. This study evaluated whether using ChloraPrep (2% alcoholic chlorhexidine) instead of 70% isopropyl alcohol wipes reduced contamination rates on two Medical Assessment Units (MAU1 and MAU2). ChloraPrep was introduced for 2 to 3-month intervention periods, initially on MAU1 and MAU2 and subsequently on MAU1 only. Contamination rates were compared with a matched time period in the preceding year and the three month period before ChloraPrep introduction. Education regarding venepucture technique was delivered. Contamination rates for the time matched pre-intervention period were 17.3% (51/295), MAU1 and 13.5% (31/230), MAU2. During the initial period of ChloraPrep use, rates declined (MAU1; 6.6% [P<0.001], MAU2; 8.5% [P=0.11] both Fisher's Exact Test). However, rates had already started to fall prior to ChloraPrep introduction. There was a non-significant difference between contamination rates in the comparator period immediately prior to ChloraPrep introduction and rates during the first intervention period (MAU1 and MAU2; P>0.05). During the second intervention period, absence of ChloraPrep on MAU2 did not significantly affect contamination (P=0.41) on this ward. ChloraPrep skin antisepsis did not give a significant reduction in blood culture contamination, but education may have led to the trend to lower contamination.
Abstract Infection with Vibrio vulnificus is uncommon in Europe but is associated with necrotisin... more Abstract Infection with Vibrio vulnificus is uncommon in Europe but is associated with necrotising wound infections and life-threatening septicaemia. This case is one of infection most likely to have been acquired from a thermal pool in Turkey without preceding ...
ABSTRACT We manage prosthetic joint infection without systemic antibiotics or prolonged hospital ... more ABSTRACT We manage prosthetic joint infection without systemic antibiotics or prolonged hospital admission (or intravenous antibiotics via outpatient intravenous services).1 We target antibiotic treatment to organisms isolated from either a diagnostic aspirate or joint washout (in the case of early infection). At the …
Figure 1 Intra-operative photograph during 1st stage showing radical soft tissue debridement and ... more Figure 1 Intra-operative photograph during 1st stage showing radical soft tissue debridement and excision of sinus. We read with interest the article by Cataldo et al. Here we report a recent case of prosthetic joint infection with an unusual organism treated successfully with minimal systemic antibiotics. A 75 year old male patient with a history of chronic lymphoid leukaemia (currently in remission) underwent a right total knee replacement for osteoarthritis at a district general hospital. Three weeks after discharge he was readmitted with a leaking wound and feeling unwell. He was subsequently taken to theatre for debridement and lavage of the right knee with retention of the prosthesis. Both fluid and one tissue sample from surgery grew Haemophilus Parainfluenzae, sensitive to amoxicillin and resistant to clarythromycin and tetracycline. The patient was treated with flucloxacillin and rifampicin for 6 weeks. Initially the patient’s general condition and knee improved. However, on stopping the antibiotics, he developed an abscess. This was aspirated and a Gram film revealed pus cells but no organisms were seen, nor subsequently cultured. The same antibiotic regime was then reinstated. One month later the patient was seen in our tertiary referral hospital by a consultant specialising in revision arthroplasty surgery. Examination revealed a discharging sinus in the proximal aspect of the wound and movements of the right knee were restricted. The CRP was 46 mg/L and ESR 82 mm/h. No organisms were cultured from a knee aspirate despite antibiotics having been stopped more than 2 weeks prior. A radical debridement with removal of the prosthesis (Fig. 1) was performed and tissue samples were sent to microbiology laboratory. The knee was stabilised with an intra-medullary rod which had been covered with antibiotic loaded bone cement. An additional 1 g of gentamicin and 2 g of vancomycin was added to each mix of Palacos cement (Heraeus Medical, Germany). Home made chains of antibiotic loaded beads with the same antibiotic combination were placed in the suprapatella pouch and both parapatellar gutters. The patient received standard prophylactic antibiotics which consisted of 3 doses of cefuroxime (750 mg). He received no further systemic antibiotics. His post operative recovery was uneventful.
Uploads
Papers by Rob Townsend