Non-suppurative Tissue Reaction to Polyether Ether Ketone Anchor in Rotator Cuff Repair.

Introduction: Interferential screws and anchors have played a major role in fixation of soft tissue to bony tunnel. With advent of time, there developed metal anchors, biodegradable anchors, bioinert anchors, etc. Biodegradable anchors had complications such as reactive synovitis, cyst formation, soft-tissue inflammation, and local osteolysis. Polyether ether ketone (PEEK) which was biologically inert and radiolucent was introduced to overcome the disadvantages of anchors. We present a case of non-suppurative tissue reaction to PEEK anchor following rotator cuff repair. Case Report: A 58-year-old male patient presented to us with signs of rotator cuff tear following injury to his shoulder. Magnetic resonance imaging depicted a massive cuff tear with retraction of cuff. Considering the degree of cuff tear, cuff was repaired with mini open method using two metallic suture anchor and two PEEK knotless bioraptor foot print suture anchor. Surgical wound healing was uneventful and suture was removed on 14th day following surgery. Three weeks following surgery, the patient had pain and rise in temperature over shoulder with raised erythrocyte sedimentation rate and C-reactive protein which subsided in 7 days with empirical antibiotics. Later, at 3 months, the patient had serous discharge from surgical site, on which exploration revealed pale yellow material vicinity to PEEK anchor. Other than pus cells in smear, discharge was negative to routine culture, grams stain, and cartridge-based nucleic acid amplification test for tuberculosis. Surprisingly, surrounding muscles were healthy, red in color, and contracting to stimulation. Following removal of both the PEEK anchors, local symptoms subsided with improvement in patients shoulder function. Conclusion: There were cases of tissue reaction to PEEK material in the literature such as osteolysis and cyst formation. In addition, non-suppurative inflammation can occur in response to PEEK material. Awareness about the non-suppurative inflammation property of PEEK material may help future surgeons to manage the condition better than us.

Paediatric Long Bone Fractures Managed with Elastic Intramedullary Nails: A Retrospective Study of 30 Patients.

Elastic intramedullary nailing or titanium elastic nail (TEN) is an alternative method for the treatment of various pediatric long bone fractures. Titanium nails are preferred over plaster cast and stainless steel nails for children older than six years. Our series included 30 paediatric long bone fractures who were managed with TEN. The mean age was 9.3 years and the mean follow-up period was 28 months. A mean time of 10 weeks was recorded for the union of all fractures. The occurrence of superficial infection in three cases healed with antibiotics and minor debridement. Limb length discrepancy was seen in three cases of femur fracture, which was functionally insignificant, but it may be a potential problem needing close follow-up until skeletal maturity is attained. An elastic intramedullary nail or TEN in long bone fractures in children is a safe and minimally invasive technique that achieves stable reduction, especially in long spiral fractures till union. We attained successful union and good results in all our 30 cases with long bone fractures in children. A few complications of hardware prominence were resolved with implant removal. Long-term studies with a comparison to casting techniques in paediatric long bone fractures are required.

Recent pattern of antibiotic resistance in Staphylococcus aureus clinical isolates in Eastern India and the emergence of reduced susceptibility to vancomycin.

PURPOSE: We aimed to determine the recent pattern of antibiotic resistance and assess the vancomycin susceptibility profile of clinical Staphylococcus aureus in view of emerging reports of vancomycin creep, reduced vancomycin susceptibility (RVS), including heterogeneous vancomycin-intermediate S. aureus (hVISA) and vancomycin-intermediate S. aureus, and vancomycin resistance in S. aureus isolates. MATERIALS AND METHODS: Consecutive, nonduplicate isolates of S. aureus between July 2015 and June 2016 were subjected to antimicrobial susceptibility testing using standard disk diffusion test or Etest as per the Clinical and Laboratory Standards Institute 2015. Detection of hVISA was done by glycopeptide resistance detection Etest according to the manufacturer's instructions in strains with vancomycin minimum inhibitory concentration of 1-2 µg/ml. RESULTS: A total of 284 S. aureus were obtained from pus (175, 61.6%), respiratory tract (31, 10.9%), urine (27, 9.5%), blood (25, 8.8%), body fluids (18, 6.3%), and catheter tips (8, 2.8%). 127 (44.7%) isolates were methicillin resistant, and 158 (55.6%) were multidrug resistant. High resistance was observed to penicillin (81.7%), erythromycin (62.3%), and ciprofloxacin (52.1%), whereas the resistance was low to gentamicin (5.3%), rifampicin (8.1%), and doxycycline (9.5%). Two hundred and fifty-one (88.3%) isolates were fully susceptible to vancomycin, whereas 33 (11.6%) demonstrated RVS. All were uniformly susceptible to linezolid, tigecycline, and daptomycin. CONCLUSIONS: A moderately high percentage of S. aureus isolates demonstrated RVS, which may limit its usefulness in methicillin-resistant isolates and may be associated with increased complications in methicillin-susceptible infections. In view of increasing glycopeptide resistance, the susceptibility status of vancomycin along with other antibiotics among clinical S. aureus isolates should be investigated periodically.

In vitro Activity of Fosfomycin against Multidrug-Resistant Urinary and Nonurinary Gram-Negative Isolates.

BACKGROUND: The era of multidrug-resistant (MDR) Gram-negative bacilli (GNB) has renewed interest in fosfomycin. AIM: The present study evaluated the in vitro activity of fosfomycin against MDR urinary and nonurinary GNB isolates. MATERIALS AND METHODS: Fosfomycin susceptibility was carried out by agar dilution for a total of 279 (142 from urine and 137 from other samples) MDR-GNB. Disk diffusion was done for urinary isolates only. RESULTS: Urinary tract isolates had a high degree of susceptibility to fosfomycin (overall susceptibility, 90.8%), whereas only 42.9% of nonurinary isolates retained susceptibility to the drug. Percentage susceptibility rates for urinary and nonurinary isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. were 99%, 91.3%, 66%, 0% and 62%, 44.4%, 32%, 11%, respectively. CONCLUSION: Fosfomycin showed excellent in vitro activity for uropathogens. Large-scale evaluation of fosfomycin against MDR systemic isolates is required to evaluate its therapeutic efficacy.