amoxicillin-potassium-clavulanate-combination and Empyema--Pleural

Pleural empyema is an infrequent manifestation of extraintestinal Clostridioidesdifficile infection, with just eight cases reported in literature.. We report a new case in a 70-year-old male without comorbidities or evidence of concomitant gastrointestinal disease, and review the previous cases reported in the literature.. The isolate was susceptible to all antimicrobial tested and was negative for A+B toxins. The patient fully recovered after drainages and antimicrobial therapy with amoxicillin-clavulanate and doxycycline.. As in the previously reported cases, aspiration was the most plausible hypothesis of mechanism of infection in our patient. Empyema by Clostridioidesdifficile is a diagnostic challenge, since it is necessary to rule out that the isolation of this microorganism in pleural fluid is not a contamination. Furthermore, more evidence is needed for its treatment since data regarding this entity are still scarce.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Clostridioides; Clostridioides difficile; Empyema, Pleural; Humans; Male

Residual posttraumatic hemothoraces occur in 1% to 20% of patients managed with tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) has emerged as an alternative to thoracotomy to evacuate these retained collections. This report reviews a recent trauma unit experience with thoracoscopic evacuation of hemothoraces.. The records of all trauma patients undergoing surgical intervention for retained hemothoraces over the 30-month period January 2001 to June 2003 were reviewed.. The study included 46 patients. All sustained penetrating injuries, 40 with stab and 6 with gunshot wounds. Twenty-two, 17, and 7 patients each had one, two and three attempts at drainage with tube thoracostomy, respectively. In 37 patients (80%), retained infected/uninfected pleural fluid was successfully evacuated thoracoscopically. VATS failed in 9 (20%) patients and the procedure was converted to open thoracotomy. Dense adhesions were present in all 9 of these patients. The mean time interval between injury and thoracoscopy and thoracotomy, was 13.3 days (range 3-46 days) and 14.5 days (range 11-24 days), respectively. The mean volume of pleural fluid evacuated thoracoscopically was 650 mL. The failure of VATS evacuation correlated with the empyema rate. The median postoperative stay was 5 days for both groups.. Video-assisted thoracoscopic surgery is an accurate, safe, and reliable operative therapy for retained posttraumatic pleural collections, even in patients presenting later than the conventionally accepted 3- to 5-day window from the time of injury.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Drug Therapy, Combination; Empyema, Pleural; Female; Fever; Hemothorax; Humans; Male; Middle Aged; Suction; Thoracic Injuries; Thoracic Surgery, Video-Assisted; Treatment Outcome; Wounds, Gunshot; Wounds, Penetrating; Wounds, Stab

Topics: Aggregatibacter aphrophilus; Alcoholism; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Chest Tubes; Coinfection; Drainage; Drug Therapy, Combination; Empyema, Pleural; Gram-Positive Bacterial Infections; Humans; Imipenem; Linezolid; Male; Middle Aged; Pasteurellaceae Infections; Peptostreptococcus; Pulmonary Atelectasis; Risk Factors; Smoking

We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate.. Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively.. Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S.aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Māori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S.pneumoniae pleural antigen were important in diagnosis.. Our audit confirms the important role of S.aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendation.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Child; Child, Preschool; Cohort Studies; Community-Acquired Infections; Empyema, Pleural; Ethnicity; Female; Floxacillin; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; New Zealand; Pneumococcal Infections; Practice Guidelines as Topic; Retrospective Studies; Seasons; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes

Pneumonia is an infection of the lung parenchyma that may result in pleural thickening, effusion, or an empyema. When there is air or gas in association with purulent exudate in the pleural cavity, a pyopneumothorax exists. The progression to pyopneumothorax under tension is extremely rare. We present a case of tension pyopneumothorax in a child.

Topics: Amoxicillin-Potassium Clavulanate Combination; Asthma; Chest Tubes; Child; Child, Preschool; Conscious Sedation; Diagnosis, Differential; Diagnostic Errors; Disease Progression; Drug Therapy, Combination; Emergency Treatment; Empyema, Pleural; Female; Humans; Pneumothorax; Risk Factors; Tachycardia; Thoracic Surgery, Video-Assisted; Thoracoscopy

The results of treatment of pyothorax using systemic antibiotics, drainage, and lavage of the pleural space, are reported for 9 dogs. All 9 dogs recovered completely. In 8 of the 9 dogs the follow-up period was at least 6 months and in none was there a relapse. The results obtained with this treatment are excellent in comparison with the results that have been reported for treatment with systemic antibiotics and drainage of the pleural space but without lavage. Apart from the addition of pleural lavage to the treatment protocol, the better result might be because migrating plant related foreign bodies did not seem to play an important role in the pathogenesis of pyothorax in this group of dogs.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Infective Agents; Dog Diseases; Dogs; Drainage; Drug Therapy, Combination; Empyema, Pleural; Female; Male; Metronidazole; Pleura; Pleural Effusion; Radiography, Thoracic; Therapeutic Irrigation

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Community-Acquired Infections; Drug Therapy, Combination; Empyema, Pleural; Humans; Lung Abscess; Lung Diseases, Obstructive; Microbial Sensitivity Tests; Pleurisy; Pneumonia, Bacterial; Respiratory Tract Infections

A blood-culture isolate of Bacteroides fragilis, taken from a woman after elective laparotomy, was resistant to metronidazole and had reduced susceptibility to imipenem and co-amoxiclav. After treatment with imipenem, pus drained from the pleural cavity yielded an identical isolate that had become highly resistant to imipenem and co-amoxiclav. Emergence of full resistance to the beta-lactam antibiotics was accompanied by a tenfold rise in the specific activity of a metallo-beta-lactamase. Clinicians need to be alert to simultaneous resistance to metronidazole, co-amoxiclav, and imipenem and development of high-level resistance to imipenem in B fragilis during treatment with this agent.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Bacteroides fragilis; Bacteroides Infections; Clavulanic Acids; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Therapy, Combination; Empyema, Pleural; Female; Humans; Imipenem; Metronidazole