Post operative analgesia using Modified PEC 2 Block in patient posted for Modified Radical Mastectomy - A Case Series

Patients undergoing modified radical mastectomy (MRM) experience lot of pain and require higher doses of analgesics. The modified pectoral nerves (m-PEC 2) block for post-operative analgesia for patients undergoing MRM has proven highly efficacious and best alternative to avoid high dose opioid induced side effects. The m -PEC 2 block was given to 5 patients undergoing modified radical mastectomy for post operative analgesia, decrease in the VAS score was noted and decrease need of rescue analgesia was seen

Multidrug-resistant Bacteroides fragilis Isolated from a Case of Pyopneumothorax.

Aim: The aim of this case report is to present an unusual case of multidrug- resistant Bacteroides fragilis from a patient with pyopneumothorax who had a blunt injury to the thorax and got admitted in a tertiary care hospital, South India. Presentation of Case: The patient developed pyopneumothorax after a blunt injury and on admission was treated empirically with piperacillin-tazobactam and metronidazole. Following antibiotic sensitivity testing the B. fragilis strain isolated showed multidrug resistance including metronidazole. Imipenem was initiated replacing empiric therapy with a successful clinical outcome. Discussion: Bacteroides species are obligate anaerobic bacteria that are usually found in the gastrointestinal tract of the human body. Bacteroides species are the most commonly isolated anaerobic organisms from intra-abdominal lesions and rarely from intrathoracic disease conditions like pyopneumothorax. Pyopneumothorax caused by Bacteroides species is associated with high treatment failure and mortality rates in antibiotic-resistant cases. Though metronidazole is the mainstay of treating anaerobic infections, attention has to be given to the possibility of multidrug resistance when treating critical diseases. Conclusion: This case report summarizes the multidrug- resistance in Bacteroides fragilis strain isolated from a case of pyopneumothorax. The situation calls attention to the possibility of multidrug-resistance being underestimated when given as empirical therapy and institution of appropriate and timely antibiotic policy measures to prevent mortality.