Multi-Drug-Resistant Gram-Negative Infections in Deployment-Related Trauma Patients.

BACKGROUND: The contribution of multi-drug-resistant gram-negative bacilli infections (MDRGN-I) in patients with trauma is not well described. We present characteristics of MDRGN-Is among military personnel with deployment-related trauma (2009-2014). PATIENTS AND METHODS: Data from the Trauma Infectious Disease Outcomes Study were assessed for infectious outcomes and microbial recovery. Infections were classified using standardized definitions. Gram-negative bacilli were defined as multi-drug-resistant if they showed resistance to ≥3 antibiotic classes or were producers of extended-spectrum ß-lactamase or carbapenemases. RESULTS: Among 2,699 patients admitted to participating U.S. hospitals, 913 (33.8%) experienced ≥1 infection event, of which 245 (26.8%) had a MDRGN-I. There were 543 MDRGN-I events (24.6% of unique 2,210 infections) with Escherichia coli (48.3%), Acinetobacter spp. (38.6%), and Klebsiella pneumoniae (8.4%) as the most common MDRGN isolates. Incidence of MDRGN-I was 9.1% (95% confidence interval [CI]: 8.0-10.2). Median time to MDRGN-I event was seven days with 75% occurring within 13 days post-trauma. Patients with MDRGN-Is had a greater proportion of blast injuries (84.1% vs. 62.5%; p < 0.0001), traumatic amputations (57.5% vs. 16.3%; p < 0.0001), and higher injury severity (82.0% had injury severity score ≥25 vs. 33.7%; p < 0.0001) compared with patients with either no infections or non-MDRGN-Is. Furthermore, MDRGN-I patients were more frequently admitted to the intensive care unit (90.5% vs. 48.5%; p < 0.0001), colonized with a MDRGN before infection (58.0% vs. 14.7%; p < 0.0001), and required mechanical ventilation (78.0% vs. 28.8% p < 0.0001). Antibiotic exposure before the MDRGN-I event was significantly higher across antibiotic classes except first generation cephalosporins and tetracyclines, which were very commonly used with all patients. Regarding outcomes, patients with MDRGN-Is had a longer length of hospitalization than the comparator group (53 vs. 18 days; p < 0.0001). CONCLUSIONS: We found a high rate of MDRGN-I in our population characterized by longer hospitalization and greater injury severity. These findings inform treatment and infection control decisions in the trauma patient population.

Band saw injury in a butcher.

BACKGROUND: While treating an unusual amputation caused by a meat band saw in a 35-year-old butcher, we sought information from the medical literature that would be useful to other physicians who might encounter similar occupational injuries. METHODS: Using the Medline database and relevant search terms, we reviewed the literature concerning occupational saw blade injuries and porcine microbiology as they related to this injury. RESULTS: Among meat workers using powered cutting equipment, hand injuries and distal fingertip amputations appear to be common. The greatest risk for a wound infection after open exposure to raw pork meat appears primarily related to environmental flora rather than enteric-borne porcine pathogens. CONCLUSIONS: Decision-making strategy when formulating a treatment plan for debridement or reconstruction of saw blade amputations should rely on a detailed understanding of the injury and occupational environment to achieve an optimal patient outcome. When considering operative and antibiotic treatment for porcine meat-related amputation injury, surgeons should adhere to open fracture-related guidelines, since porcine-borne illnesses are most often caused by ingestion rather than transcutaneous inoculation.

Isolation of Carnobacterium piscicola from human pus--case report.

Carnobacterium piscicola was first described in 1984. These bacteria are often isolated from fish afflicted with bacterial infections. To date, there has been no reported isolation of this bacterium from human specimens. We report here the isolation of C. piscicola from the pus following traumatic amputation of the right hand in the wrist of a 35-year-old man. The traumatic amputation occurred with an industrial water sawmill. The identity of the human strain was determined biochemically, by 16S rDNA sequence similarity and by fatty-acid methyl-ester profile from bacterial cell.

[The dynamics of the wound microflora in the victims of the earthquake in Armenia]. / Dinamika mikroflory ran postradavshikh pri zemletriasenii v Armenii.

The data on the composition of wound microflora, as well as changes in the contamination index over the course of treatment of patients with the syndrome of prolonged compression, who were brought to the institute after the earthquake in Armenia, are presented. The authors characterize the structure of the causative agents of wound infection in the patients treated at the traumatological department of the institute over several years. The epidemiological situation in the hospital in the period when the earthquake victims were treated there is analyzed.

Bacillus cereus-induced myonecrosis.

A patient with an incomplete amputation due to a crush injury to his arm developed a myonecrosis with Gram-positive rods noted on muscle and wound aspirates. The patient was treated for a probable Clostridium perfringens infection but culture results proved the organism to be Bacillus cereus. In light of the reported resistance of Bacillus cereus to penicillin, this case serves to emphasize the importance of expanded empiric coverage with high-dose penicillin and an aminoglycoside pending the return of culture and sensitivity results.

[Dynamics of the ultrastructural changes in opportunistic bacteria in the suppurative wound of an autografted extremity]. / Dinamika ul'trastrukturnykh izmenenii nekotorykh uslovnopatogennykh bakterii v gnoinoi rane autotransplantirovannoi konechnosti.

The electron-microscopic study of opportunistic bacteria under conditions of a suppurative inflammatory process developing in the autotransplanted extremity in white rats was carried out. The staphylococcal infection of the wound on the autotransplanted extremity in white rats was accompanied by the appearance of a capsule-like formation on the bacterial cell wall, similar to the immunoglobulin covering on the cell wall of bacteria treated with blood serum. The changes of this formation were observed in time course. After the opening and draining of the suppurative focus the contamination of the wound with Gram-negative bacteria occurred. Effective combined methods of treatment were used under experimental and clinical conditions.

Quantitative wound cultures in upper extremity trauma.

In a prospective study, 64 traumatic wounds to the hand and forearm were examined for infection by quantitative smear (Gram stain) and culture to determine whether significant wound contamination had occurred and to help in making the decisions regarding use of antibiotics and immediate or delayed closure. Sepsis developed in 23 of the 64 patients. The smears, available in 25 to 30 minutes, gave correct indications regarding development or absence of sepsis in 54 patients (84%); and the cultures, available in 24 to 36 hours, did so in 57 (89%). Prophylactic treatment with antibiotics in 36 patients was deemed unnecessary or inappropriate in 24 (smear and culture both negative, or organisms resistant to the agent). Quantitative smears and cultures, undertaken immediately by the techniques used in this study, are of practical value in management of traumatic wounds to the hand and forearm.

[Wound microflora in injured patients]. / Mikroflora ran u travmatologicheskikh bol'nykh.

The authors present the results of bacteriological study of fresh wounds in 165 traumatological patients and data on the character of microbial flora in the occurrence of purulent inflammatory complications. Microbes revealed in fresh wounds proved to differ by their species composition and antibiotic sensitivity from these causing suppuration. Purulent inflammatory complications were mostly caused by microbes which were not revealed in the wound at first.