Septic arthritis of native hip joint by Staphylococcus lugdunensis: a case report

Abstract Staphylococcus lugdunensis is a rare virulent coagulase-negative staphylococcus (CoNS) that behaves similarly to Staphylococcus aureus in causing deep abscesses, skin and soft tissue infections, and central nervous system infections. Additionally, there can be certain blood stream infections including sepsis, septic shock, toxic shock syndrome, and endocarditis complicated by embolic events. Reports of septic arthritis of a native joint associated with this organism have been infrequent, justifying the presentation and discussion of this case.

The Etiology and Clinical Features of Acute Osteoarthritis in Children; 2003-2009 / 소아감염

PURPOSE: This study was performed for the purpose of finding causative organisms and clinical features of septic arthritis or acute osteomyelitis in children. METHODS: The study involved a retrospective review of the medical records of 63 microbiologically confirmed cases of acute pyogenic arthritis and osteomyelitis. All of the cases were brought about by community-associated infections and managed at the Seoul National University Children's Hospital or Seoul National University Bundang Hospital from June 2003 to July 2009. RESULTS: The median age of all cases was 60 months and there were 35 males and 28 females. Major involved joints included the hip joint (15 cases), knee joint (7 cases), shoulder joint (4 cases), and elbow joint (4 cases). Also, major involved bones included the femur (20 cases), tibia (13 cases), humerus (7 cases), and radius (7 cases). Staphylococcus aureus was the most commonly identified causative organism, accounting for 49 cases (77.8%). Of the 49 isolates of S. aureus, methicillin-resistant S. aureus (MRSA) accounted for 8 cases (16.3%). Group B streptococcus spp. (GBS) and Salmonella spp. accounted for 3 cases, respectively. Nafcillin or cefazolin was often prescribed as an initial empirical antibiotic. There were 9 cases that were managed by a regimen that included vancomycin as the first choice. Fifty four cases (85.7%) recovered without any complications. Methicillin-sensitive S. aureus (MSSA), responsible for 41 cases, caused chronic complications in 3 cases. Of 8 cases caused by MRSA, 1 case showed chronic complication. There were no fatal cases. CONCLUSION: S. aureus remains the most common organism causing acute pyogenic arthritis and osteomyelitis of childhood acquired in the community. The high prevalence of methicillin resistance among S. aureus should be considered carefully in the selection of initial empirical antibiotics.

Regional outbreak of staphylococcal scalded skin syndrome in healthy children / 소아과

PURPOSE: Staphylococcal scalded skin syndrome (SSSS) is a relatively uncommon superficial blistering skin disease that is due to Staphylococcus aureus. We had experienced a regional outbreak of SSSS over 3 years in healthy children. METHODS: We retrospectively reviewed the medical records of those patients diagnosed as SSSS. Most of neonatal cases were nosocomial infections and excluded from the analysis. The clinical features, laboratory findings, the isolation and antibiotic resistance of S. aureus, the antibiotic management and other supportive treatments were analyzed. RESULTS: Fifty-five patients with SSSS were admitted to our hospital from October 2001 to September 2004. The median age of patients was 3.0 years. Of the 55 patients, 9 were the generalized type, 13 were the intermediate type and 33 were the scarletiniform rash. All the patients were living in neighborhood of the Jinju area. S. aureus were isolated from 9 of the patients and all of the isolated S. aureus were methicillin resistant. All the patients except two were treated with intravenous flocloxacillin or nafcillin and/or cefotaxime. All the patients recovered during the follow-up period of 2 to 3 weeks. CONCLUSION: We experienced a regional outbreak of SSSS in previous healthy children. Further study for finding the carriers of S. aureus caused SSSS and preventing the spread of this disease is needed. Additionally, guidelines for treating SSSS due to methicillin resistant S. aureus should be established.

The effectiveness of hyaluronidase for calcium gluconate-inducing extravasation necrosis : a dose and time response

Extravasation necrosis due to intravenously administered fluids and drugs is an increasing problem in hospital practice. The incidence of extravasation is variable but skin necrosis is a potentially devastating complication of intravenous therapy. Local injection of hyaluronidase has been recommended for several types of infusion extravasations. The previous studies found hyaluronidase to be effective in the prevention of necrosis following intradermal nafcillin, 12% dextrose, sodium bicarbonate, aminophylline or vince alkaloids.The objectives of the study are to determine the dosage of hyaluronidase which is effective in reducing extravasation necrosis caused by 10% calcium-gluconate and to establish how soon after this extravasation it must be given to retain its effectiveness.Study I evaluated control versus only normal saline group and normal saline with hyaluronidase groups (dose:75,150,300,450 units; all in volume 2 ml, treatment delay:immediate, 15-minutes delay, half hour delay, one hour delay, three hour delay). Size and rate of eschar were compared between groups. Study II was undertaken to examine the evolution of calcium-gluconate induced soft tissue injury in the rabbit. The histologic findings of extravasation sites were compared between groups. A statistically significant protective effect was found in the treated group versus the nontreated group within 15 minutes to 30 minutes. The most effective protection was achieved by the immediate injection of 300 units dosage of hyaluronidase.In conclusion, in the 10% calcium gluconate-induced extravasation, the given data suggest that one can expect the most protective effect with a 300 units dosage of hyaluronidase and within half-hour delay in the treatment group.

Aztreonam in the treatment of soft tissue infections including diabetic foot infections

La eficacia y seguridad de aztreonam fue evaluada en 23 pacientes con infecciones agudas de tejido blando que incluían celulitis, úlceras, abscesos e infecciones de herida. Los pacientes recibieron las siguientes dosis endovenosas de aztreonam: 16 pacientes recibieron 1gm cada 8 horas, 5 pacientes recibieron 1gms cada 8 horas y 2 pacientes recibieron 0.5gm cada 8 horas. Una segunda droga fue administrada concomitantemente con aztreonam por vía endovenosa en la siguiente forma: 20 pacientes recibieron nafcilina 2gms cada 4 horas y 3 pacientes recibieron clindamicina 0.6gm cada 6 horas. La mayoría de los pacientes estaban seriamente enfermos con condiciones subyacentes como diabetes mellitus de un promedio de duración de 14 años (límites entre 2 y 40 años) en 19 de 23 pacientes (82%). Escherichia coli fue el organismo aislado más frecuentemente. La respuesta clínica demostró cura en 23/23 pacientes tratados. La respuesta bacteriológica demostró cura en 20/23 pacientes. Hubo 3 fallas bacteriológicas: la primera fue una superinfección con Pseudomonas maltophilia la segunda fue una pulmonía adquirida en el hospital y la tercera fue una superinfección con flora mixta (Enterococo, Staphylococcus aureus y Enterobacter aerogenes). No se documentaron efectos adversos serios. Aztreonam resultó ser un agente efectivo, seguro y valioso en el tratamiento de infecciones agudas de tejido blando causadas por bacilos aeróbicos gram-negativos susceptibles