Mycobacterium smegmatis infection in a healthy woman following a facelift: case report and review of the literature.

In a 35-year-old female HIV-negative patient a facelift was followed by a Pseudomonas aeruginosa wound infection. The infection persisted despite treatment with ciprofloxacin, and an additional bacteriological wound examination revealed Mycobacterium smegmatis as the causative agent. Combination therapy with ciprofloxacin, doxycycline and amikacin led to a slow healing process without the need for further surgical intervention. A relapse 6 months after initial therapy was successfully treated with local measures. Infection with M. smegmatis might have come about by contaminated intraoperative liquids or the application of lipid creams to the open wound. However, microbiological examination of potential sources remained negative. Infection caused by M. smegmatis following plastic surgery should be considered in patients with spontaneous ulceration and violaceous discoloration of the skin adjacent to the surgical wound. Prolonged antibiotic therapy and possibly repeat surgical interventions may become necessary to treat this rare infection.

Clinical significance of extraintestinal Hafnia alvei isolates from 61 patients and review of the literature.

Hafnia alvei is a gram-negative bacterium that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, meningitis, bacteremia, pneumonia, nosocomial wound infections, endophthalmitis, and a buttock abscess. We studied 80 H. alvei isolates recovered from 61 patients within a period of 30 months. H. alvei was cultured from sites that included the respiratory tract (n = 38), the gastrointestinal tract (n = 16), and the urogenital tract (n = 12); the organism was found in blood cultures (n = 8), on central venous catheters (n = 3), and on the skin (n = 3). Only 25% of H. alvei isolates were recovered in pure cultures. Fifty-seven (93.4%) of the patients had an underlying illness. H. alvei proved to be the etiologic agent in two episodes of septicemia and in one episode of peritonitis and was probably responsible for septicemia in two other patients and pneumonia in one. All six of these patients recovered after receiving antibiotic treatment and/or standard surgical treatment, when needed. Three of these infections were nosocomial, and three were community acquired. Of the strains of H. alvei tested in our study, 100% were susceptible to netilmicin, ciprofloxacin, and imipenem; 92% were susceptible to piperacillin; 90% were susceptible to co-trimoxazole; and 88% were susceptible to ceftriaxone and ceftazidime. In this study, we found H. alvei to be a rare significant etiologic agent of nosocomial and community-acquired infections.

[Significance of Staphylococcus aureus in nose operations. Risk of toxic shock syndrome?]. / Bedeutung von Staphylococcus aureus bei Nasenoperationen. Gefahr des Toxic-shock-Syndroms?

In a prospective clinical trial the pre- and postoperative presence of S. aureus was examined in 130 patients undergoing nasal septal surgery. The patients were randomized into three groups. The first group received no perioperative antibiotics, the second group was given oral amoxicillin plus clavulanic acid, while the third group was treated with oral sulfamethoxazol and trimethoprim. A significant decrease in the incidence of S. aureus was observed in post-operative cultures, but the difference was not attributable to the antibiotic use. Overall, 18.9% of the S. aureus carriers harbored toxic shock syndrome toxin-1 positive strains. However, the decrease in the presence of S. aureus and the risk for toxic shock syndrome was not influenced by the antibiotics administered. These findings show that the routine use of oral prophylactic antibiotics for patients undergoing nasal surgery seems not indicated.