ro13-9904 and Osteomyelitis

Salmonella osteomyelitis is rare in patients without sickling hemoglobinopathies. Invasive disease caused by Salmonella Paratyphi C is rarer still with only one case reported in the United Kingdom in the last 15 years. We report a case of relapsing S. Paratyphi C osteomyelitis in a newly diagnosed diabetic patient from Ghana. Our patient was initially treated successfully with surgical debridement followed by 6 weeks of IV ceftriaxone before recrudescence 9 months later. Due to the rarity of S. Paratyphi C and the lack of recent travel, genomic analysis was undertaken to assess possible sources with the closest related strain being from Cote d'Ivoire. The patient had likley picked up the strain several years before presentation. We review current Salmonella osteomyelitis literature and audit all cases referred to the England and Wales Salmonella national reference laboratory over the last 15 years.

Topics: Ceftriaxone; Humans; Osteomyelitis; Salmonella; Salmonella Infections; Salmonella paratyphi C

Diagnosing multifactorial, multidimensional symptoms unexplained by presumptive diagnosis is often challenging for infectious disease specialists.. We report a rare case of a 30-year-old Japanese bisexual man with a history of virally suppressed human immunodeficiency virus and syphilis infections who developed chest pain and an erosive lesion under the lower midline jaw.. Imaging examinations revealed erosive lesions on the sternum and left the ninth rib. Biopsy and polymerase chain reaction testing of sternal tissue specimens were noncontributory. However, due to elevated rapid plasma regain levels, a diagnosis of syphilitic osteomyelitis and gumma of the jaw was made.. The patient was treated with 5 weeks of intravenous ceftriaxone and then with 8 weeks of oral amoxicillin.. After the antibiotic treatment, bone pain disappeared. We conducted a literature review on syphilitic osteomyelitis, and all of the articles included were case reports. Approximately half of the 46 patients with syphilitic osteomyelitis had HIV coinfection, and 10 (22%) patients lacked signs of early syphilis. Given its rarity, clinical data to establish appropriate guidelines for diagnosing and treating syphilitic osteomyelitis are still lacking. Cognitive biases, such as anchoring, cognitive overload bias, and premature closure, may contribute to diagnostic delays.. In cases of idiopathic multiple bone lesions, syphilis must always be ruled out, and clinicians should guard against cognitive pitfalls when diagnosing rare diseases.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Bias; Ceftriaxone; Clinical Reasoning; Cognition; HIV Infections; Humans; Male; Osteomyelitis; Syphilis

We report a case of Lemierre syndrome secondary to Streptococcus pyogenes in a 22-month-old girl. This case report and literature review took place at a pediatric intensive care unit at a freestanding tertiary children's hospital. Diagnosis occurred after the discovery of left internal jugular thrombus and multiple metastatic infection sites including the right knee, kidneys, lungs, and brain. Lemierre syndrome can occur in young children secondary to S. pyogenes, and a classic presentation may not occur. A high index of suspicion is crucial to the diagnosis.

Topics: Ampicillin; Anti-Bacterial Agents; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Female; Fever; Genetic Predisposition to Disease; Heterozygote; Humans; Jugular Veins; Lemierre Syndrome; Methylenetetrahydrofolate Reductase (NADPH2); Osteomyelitis; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Thrombophilia

Actinomycosis is an uncommon chronic granulomatous infection that cause formation of abscesses and cutaneous fistula. In mandibular actinomycosis the alveolar bone and mandibular body are usually not involved and the pathogenetic mechanisms of the actinomycotic infiltration is unknown. The patients usually report pain at the alveolar arch with development of a purplish-red swelling firmly attached to the mandibula; the fibrous tissue produces the continued development of new cutaneous fistulas with oncoming pus-secretion. An uncommon case of actinomycotic osteomyelitis with a double pathological fracture of mandibula is reported. Ortopanoramic X-ray and computed tomography scan of the mandibula are effective and relevant diagnostic procedures to quantify the entity and site of the osteolitic areas and to define the precise position of fractures. In association with the intravenous infusion of benzilpenicillina, daily local irrigations of rifamicina have been performed. Moreover, the patient underwent surgical drainage of abscesses with accurate curettage of osteomyelitic lesions and several biopsies of the trabecolar bone and fistulas were taken. It has been also necessary to perform a mandibular blockage using a resinal plaque anchored on premolars. To reach a precise diagnosis, an histopathological examination togheter with batterioscopic-coltural examination is needed. Antibiotic therapy alone is not a sufficient therapeutic approach and surgical treatment must be quickly performed with clean up of the osteomyelitic lesions and contention of fractures by alveolar blockage for at least 40 days.

Topics: Abscess; Actinomycosis; Adult; Anti-Bacterial Agents; Biopsy; Ceftriaxone; Combined Modality Therapy; Cutaneous Fistula; Drainage; Drug Therapy, Combination; Fractures, Spontaneous; Humans; Male; Mandibular Fractures; Osteomyelitis; Penicillin G; Radiography, Panoramic; Rifamycins; Surgical Wound Infection; Tomography, X-Ray Computed; Tooth Extraction

Staphylococcus aureus is a well recognized pathogen with global distribution. In recent years community-associated, methicillin-resistant S. aureus has emerged as an increasing cause of severe infections among adults and children. Herein, a case is reported of a previously healthy, 19-month-old male, who presented with empyema necessitans and acute osteomyelitis due to a community-associated, methicillin-resistant, S. aureus strain. This report highlights the evolving epidemiology of S. aureus, as important pathogen in the community as well as the hospital setting, and the importance of establishing appropriate guidelines for diagnosis, management and surveillance of this public health problem.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Clindamycin; Combined Modality Therapy; Community-Acquired Infections; Drug Therapy, Combination; Empyema, Pleural; Femoral Vein; Femur; Gentamicins; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Popliteal Vein; Radiography; Staphylococcal Infections; Thoracoscopy; Vancomycin; Venous Thrombosis

We present the first case of Salmonella virchow causing a relapsing bone infection at the same site 12 years apart in an otherwise healthy patient. Chronic relapsing osteomyelitis caused by a zoonotic salmonella may become increasingly important in view of the increased incidence of zoonotic salmonella infections. Based on this case, we recommend 3 months of therapy with a quinolone when treating a chronic relapsing zoonotic salmonella osteomyelitis.

Topics: Adult; Anti-Infective Agents; Cefazolin; Ceftriaxone; Cephalosporins; Chronic Disease; Ciprofloxacin; Drug Therapy, Combination; Floxacillin; Humans; Immunocompetence; Male; Osteomyelitis; Penicillins; Recurrence; Salmonella; Salmonella Infections; Time Factors

Osteomyelitis of the frontal bone may be associated with a purulent collection under the periosteum, causing swelling and edema over the forehead, a condition known as Pott's puffy tumor. We describe an 83-year-old man with a Pott's puffy tumor due to Haemophilus influenzae that was successfully treated with surgery and antibiotics. A review of 22 cases of Pott's puffy tumor shows that this condition usually occurs in children, is spread from frontal or ethmoid sinusitis, and is usually due to streptococci, staphylococci, or anaerobes. Suppurative complications such as epidural, subdural, and intracerebral abscesses are common. Only seven cases of Pott's puffy tumor in adults have been reported, and only one of these cases was caused by H. influenzae. Surgical drainage and antibiotic therapy remain standard therapy for this condition.

Topics: Aged; Aged, 80 and over; Cefprozil; Ceftriaxone; Cephalosporins; Follow-Up Studies; Frontal Bone; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Osteomyelitis; Radiography; Tomography Scanners, X-Ray Computed

Ceftriaxone is an effective and safe agent for the treatment of osteomyelitis. It is active against most of the causative organisms. Combined with surgery, it is useful for all types of osteomyelitis. In addition, its once-daily dosing has made outpatient therapy feasible for most patients. Questions that remain are whether full treatment with 2 gm every 24 hours for four to six weeks is needed for osteomyelitis or whether 1 gm/day would provide comparable results. The relevance of minimal inhibitory/bactericidal concentrations and serum inhibitory/bactericidal concentrations has not been-determined. Some questions remain about the cure rate of ceftriaxone against S. aureus osteomyelitis, although most cases do well. Comparative studies with agents such as cefazolin or oxacillin would be helpful to resolve this issue. Long-term follow-up of patients treated for osteomyelitis outcome has not been done in sufficient detail to be certain of the comparative results of different antimicrobials. The success rate of the quinolones against gram-negative osteomyelitis appears good, but their activity against gram-positive organisms is uncertain, and development of resistance is a problem. Questions still linger in regard to how much can be accomplished with antimicrobial therapy without surgery and how long antimicrobials are needed once effective surgery has been performed.

Topics: Bacterial Infections; Ceftriaxone; Follow-Up Studies; Humans; Osteomyelitis; Outpatients

Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone-sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8-18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50-55% porosity, average pore size 110 μm, higher interconnectivity (10-100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients.

Topics: Adolescent; Adult; Animals; Ceftriaxone; Chronic Disease; Drug Delivery Systems; Female; Humans; Male; Materials Testing; Middle Aged; Osteomyelitis; Rabbits; Staphylococcus; Sulbactam; Tibia; Tomography, X-Ray Computed; Translational Research, Biomedical; Young Adult

Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.

Topics: Administration, Oral; Amoxicillin; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Fever; Humans; Infant; Injections, Intramuscular; Meningitis, Bacterial; Microbial Sensitivity Tests; Osteomyelitis; Otitis Media; Pneumonia; Prospective Studies

In a prospective study 105 children hospitalized with soft tissue infection, 11 children with suppurative arthritis and 9 children with osteomyelitis were treated with either parenterally administered ampicillin/sulbactam or ceftriaxone. Treatment was randomized using a computer-generated table in a 2:1 fashion: 84 patients received ampicillin/sulbactam and 41 patients received ceftriaxone. Organisms isolated from wound site or blood cultures included Staphylococcus aureus (33), Streptococcus pyogenes (19), Haemophilus influenzae (9) including 4 beta-lactamase-positive organisms, Streptococcus pneumoniae (5), Neisseria gonorrhoeae (3) and 9 other organisms. Clinical and bacteriologic response was satisfactory in 100% of the ampicillin/sulbactam-treated patients and in 93% of the ceftriaxone-treated patients. Two patients with S. aureus infections treated with ceftriaxone had a delayed response and required change in therapy to parenterally administered oxacillin. Ampicillin/sulbactam represents a potentially useful single agent for the treatment of cellulitis and bone or joint infections in pediatric patients.

Topics: Acinetobacter Infections; Adolescent; Ampicillin; Arthritis, Infectious; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gonorrhea; Haemophilus Infections; Humans; Infant; Male; Osteomyelitis; Prospective Studies; Random Allocation; Staphylococcal Infections; Streptococcal Infections; Sulbactam

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cellulitis; Clinical Trials as Topic; Humans; Osteomyelitis; Pneumonia

An immunocompetent 49-year-old man presented with swelling and pain in the lower region of his left leg that had lasted for 4 weeks. The diagnosis was severe pyomyositis and osteomyelitis in the lower left leg caused by hypervirulent

Topics: Ceftriaxone; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Male; Middle Aged; Osteomyelitis; Pyomyositis

A 16-year-old man was hospitalised with a painful space-occupying lesion in his posterior neck involving muscles, soft tissues, C1 cervical vertebra and vital cervical blood vessels. The true-cut biopsy showed inflammatory tissue. The microbiological analysis, which combined classical bacteriological and molecular methods, yielded at least four different anaerobic species. The patient was treated successfully with a prolonged course of ceftriaxone and metronidazole.

Topics: Abscess; Adolescent; Ceftriaxone; Cervical Vertebrae; Humans; Male; Neck; Osteomyelitis

Topics: Adult; Anti-Bacterial Agents; Athletic Injuries; Ceftriaxone; Debridement; Diagnosis, Differential; Fever; Groin; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Muscle, Skeletal; Osteomyelitis; Pubic Symphysis; Running

Topics: Administration, Intranasal; Administration, Intravenous; Adult; Anti-Bacterial Agents; Betamethasone; Ceftriaxone; Drainage; Frontal Bone; Frontal Sinusitis; Glucocorticoids; Humans; Male; Osteomyelitis; Pott Puffy Tumor; Tomography, X-Ray Computed

Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew

Topics: Administration, Intravenous; Anti-Bacterial Agents; Antifungal Agents; Candida albicans; Candidiasis; Ceftriaxone; Child, Preschool; Facial Paralysis; Female; Fluconazole; Humans; Magnetic Resonance Imaging; Mastoid; Mastoidectomy; Metronidazole; Osteomyelitis; Skull Base; Tomography, X-Ray Computed

Topics: Adolescent; Anti-Bacterial Agents; Arrhythmias, Cardiac; Ceftriaxone; Child; Child, Preschool; Female; Heart Block; Hospitals, Pediatric; Humans; Leptospirosis; Male; Osteomyelitis; Shock, Septic; Singapore; Tertiary Care Centers

Topics: Actinomycosis; Aged; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Osteomyelitis; Tobramycin

The study was carried out to evaluate the clinical and bacteriological profile of SA in young infants (age ≤ 3 months) in a tertiary referral centre and to assess the risk factors and to document the changing trends in the epidemiology.. This was a prospective descriptive study on all young infants with SA. Clinical and perinatal history, examination, radiological and laboratory findings (blood count, ESR, CRP, blood and joint cultures) were studied. Emergency arthrotomy was done and antibiotics were administered in all patients.. Thirty young infants were included with a mean age of 22 ± 13.6 days and with male-to-female ratio 1.5:1. Pseudoparalysis and pain were the most common presenting symptoms. Knee joint was most commonly involved followed by hip. Ultrasound of the joint (86%) and elevated CRP levels (97%) were found to be reliable diagnostic markers. Most common causative organism was methicillin-resistant Staphylococcus aureus (43.3%) followed by Klebsiella pneumonia (23%). Sensitivity to empirical antibiotic regimen was lower (ceftriaxone 53%, amoxicillin 35%) when compared to higher antibiotics (gentamycin 88%, vancomycin 100%). Prematurity (57%), low birthweight (73%), anaemia (80%), previous history of hospitalisation (93%) and invasive procedures (90%) were found to be important risk factors.. The disease has distinct regional variations, and the epidemiological and bacterial profile is constantly changing. There is a shift in causative organisms towards more resistant and gram-negative species. Prematurity, low birthweight and previous hospitalisation are the major predisposing factors. A better understanding of the varied presentations is necessary for an early diagnosis and treatment, which is the most important prognostic factor.

Topics: Amoxicillin; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Female; Gentamicins; Hip Joint; Humans; Infant; Infant, Newborn; Klebsiella Infections; Klebsiella pneumoniae; Knee Joint; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Prospective Studies; Staphylococcal Infections; Vancomycin

Hypervirulent strains of Klebsiella pneumoniae are a recognized cause of a distinct invasive syndrome that results in pyogenic liver abscesses and metastatic complications, particularly in the Asia Pacific region. Reports of hypervirulent K.pneumoniae in Europe, the Americas and Australia indicate worldwide spread. We present a case of multi-focal osteomyelitis, a rarely described complication of hypervirulent K.pneumoniae in the medical literature. The prevalence of this condition in countries outside Asia may be expected to rise with increasing travel.. A 20-year-old Chinese man residing in Australia for 2 years presented with a 2-week history of gradually worsening leg pain preceded by 2 weeks of constitutional symptoms. Imaging with computerized axial tomography (CT) and other modalities revealed bilateral tibial lesions described as lattice-like linear lucencies involving the cortices with scalloping of the outer involved cortex. Cultures of tissue from a left tibial bone biopsy were positive cultures for K.pneumoniae. Whole-genome sequencing identified the isolate as K1 serotype ST23, a well-recognized hyper virulent strain capable of causing invasive disease. An abdominal CT revealed a 27x22mm liver abscess. The patient had no other metastatic manifestations of the disease, and responded to 6 weeks of intravenous ceftriaxone followed by 3 months of oral Ciprofloxacin.. Increased awareness of the manifestations and subsequent management of hyper virulent strains of K.pneumoniae by clinicians is important to assist early recognition and help minimize serious sequelae. Cases with overseas links, such as previous residence in the Asia Pacific area, are at higher risk for infection with the hyper virulent strain. This case highlights the need for clinicians to be able to recognize this important disease, especially in patients with the right epidemiological links, and to investigate and treat appropriately to prevent severe metastatic complications.

Topics: Asian People; Australia; Ceftriaxone; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Male; Osteomyelitis; Serogroup; Whole Genome Sequencing; Young Adult

The developing world often lacks the resources to effectively treat the most serious injuries including osteomyelitis following open fractures or surgical fracture treatment. Antibiotic cement beads are a widely accepted method of delivering antibiotics locally to the infected area following trauma. This study is based in Cambodia, a low income country struggling to recover from a recent genocide. The study aims to test the effectiveness of locally made antibiotic beads and analyse their effectiveness after being gas sterilised, packaged and kept in storage Different antibiotic beads were manufactured locally using bone cement and tested against MRSA bacteria grown from a case of osteomyelitis. Each antibiotic was tested before and after a process of gas sterilisation as well as later being tested after storage in packaging up to 42 days. The gentamicin, vancomycin, amikacin and ceftriaxone beads all inhibited growth of the MRSA on the TSB and agar plates, both before and after gas sterilisation. All four antibiotics continued to show similar zones of inhibition after 42 days of storage. The results show significant promise to produce beads with locally obtainable ingredients in an austere environment and improve cost effectiveness by storing them in a sterilised condition.

Topics: Amikacin; Anti-Bacterial Agents; Bone Cements; Cambodia; Ceftriaxone; Cost-Benefit Analysis; Delayed-Action Preparations; Drug Delivery Systems; Drug Stability; Fractures, Open; Gentamicins; Humans; Microspheres; Osteomyelitis; Polymethyl Methacrylate; Vancomycin

Topics: Adult; Atlanto-Axial Joint; Cardiopulmonary Resuscitation; Ceftriaxone; Heart Arrest; Heroin Dependence; Humans; Hypothermia, Induced; Male; Methicillin-Resistant Staphylococcus aureus; Odontoid Process; Osteomyelitis; Quadriplegia; Substance Abuse, Intravenous; Tomography, X-Ray Computed; Vancomycin

An 84-year old woman came to the emergency department with sharp back pain on her left side that she'd had for 4 days. The pain radiated to her posterior hips when standing. She said her whole body felt achy and she was experiencing weakness in both legs.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Back Pain; Ceftriaxone; Diagnosis, Differential; Female; Humans; Intervertebral Disc Degeneration; Muscle Weakness; Osteomyelitis; Streptococcal Infections; Streptococcus

Topics: Abscess; Ceftriaxone; Humans; Infant; Kingella kingae; Male; Neisseriaceae Infections; Osteomyelitis; Tibia

A 56-year-old previously healthy man was hospitalized due to a 10-day history of neck pain and an elevated C-reactive protein level. Gram-negative spiral bacilli were isolated from his blood, and Helicobacter cinaedi was confirmed using 16S rRNA sequencing. The infectious focus was not identified by initial cervical magnetic resonance imaging (MRI); however, repeated MRI demonstrated prominent high signal intensity in the entire region of the C6-C7 vertebrae and C6/C7 disc space. Furthermore, fluorodeoxyglucose-positron emission tomography/computed tomography showed no significant uptake, other than in the C6-C7 region. The patient was successfully treated with ceftriaxone for six weeks without sequelae.

Topics: C-Reactive Protein; Ceftriaxone; Cervical Vertebrae; Diagnosis, Differential; Helicobacter; Helicobacter Infections; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; RNA, Ribosomal, 16S; Tomography, X-Ray Computed

We report a case of femorotibial osteomyelitis due to Nocardia brasiliensis. Nocardia spp are a rare cause of bone infections, and the majority of such cases are associated with the spine. This type of osteomyelitis is uncommon, and in the immunocompetent host, is more often related to a chronic evolution following direct inoculation of the microorganism.

Topics: Administration, Intravenous; Amikacin; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Imipenem; Nocardia; Nocardia Infections; Osteomyelitis; Phylogeny; Specimen Handling; Sulfamethoxazole; Trimethoprim; Young Adult

A 51-year-old previously fit and healthy gentleman sustained a circular saw injury to his right thumb with partial amputation and an open multifragmentary fracture of his distal phalanx. He underwent open reduction and internal fixation under the hand surgery team. He developed a postoperative infection discharging pus 2 weeks postoperatively, which later grew Candida parapsilosis. He underwent radical debridement and removal of a K-wire, then a further second debridement 2 days later. Ceftriaxone was started empirically while awaiting cultures. Tissue and bone biopsy samples obtained in theatre all grew C. parapsilosis and he was started on caspofungin for 1 week, and switched on to oral fluconazole to complete a 6-week course. He has progressed well and has regained function in his thumb after 3 months, without any sign of ongoing infection.

Topics: Amputation, Traumatic; Antifungal Agents; Candida; Candidiasis; Ceftriaxone; Debridement; Drug Therapy, Combination; Finger Phalanges; Fluconazole; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Thumb

Topics: Aggregatibacter aphrophilus; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Ciprofloxacin; Female; Gentamicins; Humans; Image-Guided Biopsy; Middle Aged; Osteomyelitis; Pasteurellaceae Infections; Sternoclavicular Joint; Treatment Outcome; Ultrasonography

We present a case of chronic posterior hip dislocation after severe joint destruction following septic arthritis. In the absence of trauma, infection must be considered in the differential diagnosis of a dislocated joint particularly in patients with risk factors such as intravenous drug abuse and immune compromise. Excision arthroplasty of the hip was performed with good pain relief and functional outcomes. This is an excellent temporary or permanent solution in managing such complex cases although alternative management options are discussed.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty; Ceftriaxone; Clindamycin; Debridement; Floxacillin; Heroin Dependence; Hip Dislocation; Hip Joint; Humans; Male; Methadone; Middle Aged; Opiate Substitution Treatment; Osteomyelitis; Radiography; Staphylococcal Infections; Substance Abuse, Intravenous

The outpatient parenteral antibiotic therapy (OPAT) program of the Portland Veterans Affairs Medical Center (PVAMC), which has a self-administration model, is staffed by visiting nurses from a specialist infusion company. This study evaluates the clinical outcomes of these patients.. This study was a retrospective chart review of 262 patients at PVAMC who had received OPAT between 2007 and 2009. Patients were included only if they received ongoing care at PVAMC. The data collected included conditions and organisms being treated and types and durations of antibiotics used. Clinical cure was defined as documented cure at the end of treatment and 90 days post-OPAT.. One hundred ninety patients of 262 were analyzed. The mean age was 63.2 years. Diabetes was the main comorbid factor (17%). The most common indications for OPAT were osteomyelitis (38%), urinary tract infection (23%), and skin and soft tissue infection (12.6%). Mixed bacterial culture (26%) and Staphylococcus aureus (31%) were the most common organisms treated. Vancomycin was the most frequently used antibiotic (26%) followed by ceftriaxone (12%). The median duration of OPAT was 30 days. The rate of clinical cure at end of treatment observed for all infections treated was 78%, which then decreased to 58% at 90 days post-OPAT (P < 0.001). Patients with diabetes and osteomyelitis had an increased risk of relapse at 90 days post-OPAT on multivariate analysis (P = 0.025).. An OPAT program using a self-administration model treating patients who were military veterans had successful outcomes. Patients with diabetes and osteomyelitis had worse clinical outcomes 90 days after the completion of OPAT therapy.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Diabetes Complications; Home Infusion Therapy; Humans; Middle Aged; Nafcillin; Osteomyelitis; Patient Care Team; Retrospective Studies; Time Factors; United States; United States Department of Veterans Affairs; Vancomycin

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Bacterial Typing Techniques; Ceftriaxone; Combined Modality Therapy; Debridement; Female; Humans; Immunocompetence; Ofloxacin; Osteomyelitis; Salmonella; Salmonella Infections; Tibia

Antistaphylococcal penicillins are the treatment of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infection. Ceftriaxone can be dosed once daily and is less expensive for outpatient therapy than oxacillin. We compared patient outcomes of MSSA osteoarticular infections treated with ceftriaxone versus oxacillin.. We conducted a retrospective cohort study of patients with MSSA osteoarticular infections at a tertiary care hospital from January 2005 to April 2010. We collected demographic, clinical, and outcome data including treatment-related adverse events. Successful treatment (clinical improvement; improved follow-up markers and imaging; no readmission for treatment) was compared at 3-6 months and >6 months after completion of intravenous antibiotics.. In total, 124 patients had an MSSA osteoarticular infection; 64 (52%) had orthopedic hardware involvement. Of those patients, 74 (60%) received ceftriaxone and 50 (40%) received oxacillin. Oxacillin was more often discontinued due to toxicity (9 of 50 [18%] oxacillin vs 3 of 74 [4%] ceftriaxone; P = .01). At 3-6 and >6 months, data for 97 and 88 patients, respectively, were available for analysis. Treatment success was similar at 3-6 months (50 of 60 [83%] ceftriaxone vs 32 of 37 [86%] oxacillin; P = .7) and >6 months (43 of 56 [77%] ceftriaxone vs 26 of 32 [81%] oxacillin; P = .6). After intravenous antibiotics, 56 (45%) patients received long-term suppression with oral antibiotics (31 of 74 [42%] ceftriaxone vs 25 of 50 [50%] oxacillin; P = .4).. In this comparison of ceftriaxone versus oxacillin for MSSA osteoarticular infections, there was no difference in treatment success at 3-6 and >6 months following the completion of intravenous antibiotics. Patients receiving oxacillin were more likely to have it discontinued due to toxicity.

Topics: Adult; Aged; Anti-Bacterial Agents; Arthritis; Ceftriaxone; Female; Humans; Male; Methicillin; Middle Aged; Osteomyelitis; Outpatients; Oxacillin; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

A systematic and extensive approach incorporating in vitro and in vivo experimentation to treat chronic osteomyelitis in animal model were made using antibiotic loaded special bioactive glass porous scaffolds. After thorough characterization for porosity, distribution, surface charge, a novel drug composite were infiltrated by using vacuum infiltration and freeze-drying method which was subsequently analyzed by SEM-EDAX and studied for in vitro drug elution in PBS and SBF. Osteomyelitis in rabbit was induced by inoculation of Staphylococcus aureus and optimum drug-scaffold were checked for its efficacy over control and parenteral treated animals in terms of histopathology, radiology, in vivo drug concentration in bone and serum and implant-bone interface by SEM. It was optimized that 60P samples with 60-65% porosity (bimodal distribution of macro- to micropore) with average pore size ~60 μm and higher interconnectivity, moderately high antibiotic adsorption efficiency (~49%) was ideal. Results after 42 days showed antibiotic released higher than MIC against S. aureus compared to parenteral treatment (2 injections a day for 6 weeks). In vivo drug pharmacokinetics and SEM on bone-defect interface proved superiority of CFS loaded porous bioactive glass implants over parenteral group based on infection eradication and new bone formation.

Topics: Adsorption; Animals; Anti-Bacterial Agents; Bone and Bones; Ceftriaxone; Chronic Disease; Drug Carriers; Drug Delivery Systems; Glass; Hydrogen-Ion Concentration; Osteomyelitis; Porosity; Powders; Rabbits; Staphylococcus aureus; Sulbactam

A main determinant of clinical response to antibiotic treatment is drug concentration at the infected site. Data on ceftriaxone (CFX) bone penetration are lacking. We measured CFX concentrations in infected bone to verify their relationship with pharmacodynamic microbiological markers.. Eleven patients undergoing debridement for septic non-union of the tibia and receiving intravenous CFX were studied. Plasma and bone specimens were collected intraoperatively at a variable interval after CFX administration. Drug concentrations were measured by high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method.. Bone samples were extracted at a mean of 3.3 h (range 1.5-8.0 h) since the start of CFX infusion. The mean±standard deviation intraoperative CFX plasma concentration was 128.4±30.8 mg/l; the corresponding bone concentrations were 9.6±3.4 mg/l (7.8%) in the cortical compartment and 30.8±8.6 mg/l (24.3%) in the cancellous compartment. The mean 24-h area under the concentration-time curve (AUC(24)) values were 176.8±62.2 h*mg/l in cortical bone and 461.5±106.8 h*mg/l in cancellous bone. The time above the minimum inhibitory concentration (T>MIC) was 24 h in all compartments. The estimated mean free AUC/MIC ratios and T>MIC were 140 and 24.4 h, respectively, in cancellous bone and 42.4 and 21 h, respectively, in cortical bone.. CFX bone penetration was poor (<15%) in the cortical compartment and satisfactory in the more vascularized cancellous bone. The T>MIC and AUC/MIC ratios suggest that CFX achieves a satisfactory pharmacokinetic exposure in cancellous bone as far as pathogens with a MIC of <0.5 are concerned. However, considering free drug concentrations, pharmacokinetic/pharmacodynamic targets may not be fully achieved in cortical bone. As antibiotic exposure can be suboptimal in the infected cortical compartment, and drug penetration may be impaired into necrotic bone and sequesters, a radical surgical removal of purulent and necrotic tissues appears essential to shorten treatment duration and to prevent treatment failures.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Area Under Curve; Ceftriaxone; Debridement; Fractures, Ununited; Humans; Injections, Intravenous; Microbial Sensitivity Tests; Middle Aged; Osteomyelitis; Tibia; Young Adult

Chronic osteomyelitis is still common in developing countries like Nigeria due to the fact that conditions associated with the lowering of resistance to infections like malnutrition, malaria, anaemia, and acute eruptive fever are still prevalent in our society. Various operative techniques have been described for the treatment of chronic osteomyelitis with various outcomes. A case of chronic osteomyelitis of the mandible managed using the Belfast technique is presented. The Patient was followed up for 2 years with no evidence of recurrence of infection and a repeat radiograph at the end of follow-up revealed new bone formation. The Belfast technique is effective in the treatment of chronic osteomyelitis of the mandible and is recommended in the management of this condition.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Nigeria; Osteomyelitis; Osteotomy; Polymethyl Methacrylate; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Present investigation deals with an extensive approach incorporating in vitro and in vivo experimentation to treat chronic osteomyelitis, using hydroxyapatite porous scaffolds.. Hydroxyapatite was synthesized in the laboratory by wet chemical method, different porous scaffolds have been fabricated. In vitro studies include variation of porosity with interconnectivity, pore-drug interfacial studies by SEM-EDAX and drug elution studies (by HPLC) both in contact with PBS and SBF at approximately 37 degrees C. In vivo trials were based on experimental osteomyelitis in rabbit model induced in tibia by Staphylococcus aureus. Characterizations included observation of histopathology, radiology and estimation of drug in both bone and serum for 42 days by HPLC method and subsequent bone-biomaterial interface by SEM.. It was established that lower pore percentage with a distribution of mainly micro-pores were found to be superior over the higher pore percentage both in vitro and in vivo. The criteria was matched with the 50N50H samples which had 50-55% porosity with an average pore size approximately 110 microm, having higher interconnectivity (10-100 microm), moderately high adsorption efficiency (approximately 50%) when loaded with CFS (drug combinations consisting of irreversible b-lactamase inhibitor and b-lactam antibiotic). CFS release from HAp implants were faster in PBS than SBF. Further, both the results of in vitro and in vivo drug elution after 42 days showed release higher than minimum inhibitory concentration of CFS against Staphylococcus aureus. In vivo studies also proved the superiority of CFS loaded HAp implants than parenteral group based on eradication of infection and new bone formation.. HAp based porous scaffold loaded with CFS and designed porosity (in terms of micro- and macro-porosity, interconnectivity) was found to be an ideal delivery system which could locally, sustainably release the composite antibiotic in reliable manner both in terms of in vitro drug elution behaviour in contact with SBF and in vivo animal trial.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Disease Models, Animal; Drug Compounding; Drug Delivery Systems; Durapatite; Hydrogen-Ion Concentration; Microscopy, Electron, Scanning; Osteomyelitis; Porosity; Powders; Rabbits; Staphylococcus aureus; Sulbactam; X-Ray Diffraction

Osteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the first case of osteomyelitis of the distal femur caused by Salmonella typhimurium in a patient with Crohn's disease. The infection was successfully treated with a combination of antibiotics and surgical treatment.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Crohn Disease; Femur; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Opportunistic Infections; Osteomyelitis; Postoperative Care; Postoperative Complications; Radionuclide Imaging; Salmonella Food Poisoning; Salmonella Infections; Salmonella typhimurium

We report the case of a 14-year-old girl who presented with an 8-week history of unilateral pansinusitis. In the course of the disease a right-side frontal swelling was observed, which disappeared following antibiotic treatment. Four weeks later, however, the swelling reappeared and was now diagnosed as recurrent Pott's puffy tumor. Interestingly, C-reactive protein levels were in the normal range throughout. Following functional endoscopic frontal sinusotomy, antibiotic treatment with ceftriaxone was administered over 3 weeks and led to complete remission of the lesion. Pott's puffy tumor is a subperiostal abscess of the frontal bone, usually presenting as localized swelling of the soft tissue in the overlying region of the forehead, and is associated with localized osteomyelitis and occasionally with intracranial epidural abscess. The entity has been known since 1768, although recurrent cases with normal inflammation parameters have not been published previously.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Endoscopy; Female; Frontal Bone; Humans; Osteomyelitis; Rare Diseases; Secondary Prevention; Treatment Outcome

Osteoarticular infections (OAI) are infrequent in pediatrics and there is controversy on the need for prolonged use of intravenous antimicrobials.. To characterize and describe evolution and complications of a regimen of 7 days initial intravenous antibiotic treatment for OAI in children, completing 4-6 weeks of total treatment.. In a large pediatric hospital, 70 children younger than 15 years of age were diagnosed with OAI between March 2003 and December 2004. Children received 7 days of intravenous antibiotics followed by 3 to 5 weeks of oral treatment.. Incidence of OAI in this hospital was 1.8:10000. Patients mean age was 6.4 +/-4.4 years and 60% presented with septic arthritis, 36% osteomyelitis and 4% osteoarthritis. In 80% of cases, the infection was located in the lower extremity. Positive cultures were obtained in 59% predominating Staphylococcus aureus (46.5%). Seven patients had prolonged pain or persistently high or increasing serum C reactive protein levels and were maintained on prolonged intravenous therapy. None of the 63 children with 7 day intravenous antimicrobials nor the 7 children with prolonged intravenous use developed a complication in the short-term follow up.. Seven days of intravenous antibiotic for the initial phase of OAI treatment was effective in a majority of children and may be recommended.

Topics: Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Cloxacillin; Drug Therapy, Combination; Female; Follow-Up Studies; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Infusions, Intravenous; Male; Osteoarthritis; Osteomyelitis; Treatment Outcome

The authors describe the first case of Salmonella serogroup D gas-forming femoral osteomyelitis and pyomyositis in a 51-year-old man with non-Hodgkin lymphoma. The patient was successfully treated with surgical debridement as well as clindamycin plus ceftriaxone, and then switched to ciprofloxacin. However, he eventually died due to multidrug-resistant Acinetobacter baumannii pneumonia. In addition, five cases of Salmonella gas-forming pyomyositis in the literature were reviewed.

Topics: Acinetobacter Infections; Ceftriaxone; Ciprofloxacin; Clindamycin; Cross Infection; Fatal Outcome; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Osteomyelitis; Pyomyositis; Salmonella Infections

We report the case of an elderly woman presenting with group G streptococcal septicaemia associated with osteomyelitis and endophthalmitis.

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blindness; Ceftriaxone; Chloramphenicol; Clindamycin; Dexamethasone; Endophthalmitis; Eye Enucleation; Female; Humans; Injections, Intravenous; Metatarsal Bones; Ofloxacin; Osteomyelitis; Streptococcal Infections; Streptococcus; Treatment Outcome

We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Chronic Disease; Debridement; Female; Humans; Injections, Intravenous; Manubrium; Osteomyelitis; Radiography; Sternum

The majority of data evaluating Salmonella infections in sickle cell anemia (SCD) comes from studies performed in children. We report a SCD adult who presented with ceftriaxone-resistant Salmonella bacteremia. After appropriate initial therapy, persistent back pain prompted evaluation by magnetic resonance imaging of the spine, which revealed osteomyelitis and a psoas abscess. The patient responded to percutaneous drainage and antibiotics. This report summarizes some of the findings of large SCD studies evaluating Salmonella bacteremia and osteomyelitis, focusing on adults. Our case exemplifies the need for antibiotic coverage for Salmonella species in adult SCD patients with septicemia. We argue that imaging studies looking for osteomyelitis should be done routinely in SCD patients with Salmonella bacteremia.

Topics: Adult; Anemia, Sickle Cell; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Comorbidity; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Psoas Abscess; Salmonella Infections; Salmonella paratyphi C; Sepsis

This report documents a 47-year-old male who developed acute deficits of the IX, X, XI, XII cranial nerves and Horner's symptoms, consistent with Villaret's syndrome. Neuroimaging studies demonstrated an osteolytic lesion in the skull base involving the clivus and jugular foramen. The patient recovered after the antibiotic treatment for proteus mirabilis infection. We suggest that Villaret's syndrome can be a rare presentation of skull base osteomyelitis.

Topics: Ceftriaxone; Cranial Nerve Diseases; Horner Syndrome; Humans; Male; Middle Aged; Osteomyelitis; Proteus Infections; Proteus mirabilis; Skull Base; Syndrome

A 12-year-old male presented with osteomyelitis and poliarthritis; after hospitalisation he developed subcutaneous abscesses, endocarditis and pericarditis. The diagnosis of typhoid fever was made when blood cultures grew Salmonella typhi. The patient was cured with a regimen of ceftriaxone and ciprofloxacin.

Topics: Arthritis; Ceftriaxone; Child; Ciprofloxacin; Humans; Male; Osteomyelitis; Salmonella typhi; Typhoid Fever

Within 10 days after cystoscopy causing urosepsis this patient developed persistant neckpain as initial symptom of vertebral osteomyelitis. E. coli was isolated from urine, blood cultures and later from bone biopsy. Antibiotic treatment did not stop the progress of the disease. A transverse spinal cord syndrome occurred due to a pathological fracture of C5 and C6 and operative decompression was necessary. The rapid onset of osteomyelitis was impressive. For effective treatment of bacterial osteomyelitis a bone biopsy is sometimes unavoidable and indicated.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cervical Vertebrae; Cystoscopy; Escherichia coli Infections; Humans; Male; Middle Aged; Osteomyelitis; Sepsis

Salmonella osteomyelitis of the rib is a rare clinical entity. In our case, a muhidrug resistant Salmonella enterica serotype Typhi was isolated from an immuno-competent patient with osteomyclitis of the ribs, who was treated earlier with ciprotloxacin for typhoid fever. The patient was successfully treated for osteomyclitis with intravenous ceftriaxone.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Humans; Male; Osteomyelitis; Ribs; Salmonella typhi; Typhoid Fever

Actinobacillus actinomycetemcomitans is a microaerophilic, fastidious Gram-negative rod that most commonly causes periodontitis and odontogenic infections. We report the first case of an epidural abscess and osteomyelitis due to this organism resulting from self-extraction of carious teeth. The patient responded to surgical debridement and prolonged antimicrobial therapy with intravenous ceftriaxone.

Topics: Actinobacillus Infections; Aged; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Ceftriaxone; Epidural Abscess; Humans; Male; Osteomyelitis

To examine the effects of diabetes, vascular disease, age, and antimicrobial therapy on clinical outcomes, including amputation rates, in patients with osteomyelitis treated in the outpatient setting.. We performed a retrospective chart review of patients treated with intravenous antimicrobial therapy for osteomyelitis at an outpatient infectious diseases practice. All patients were followed for at least 6 months.. Four hundred and fifty-four patients qualified for inclusion, with follow-up information available for up to 10 years. One hundred and thirty-nine patients (31%) had recurrences and 27 (6%) had amputations. Of the recurrences, 108 (78%) occurred within 6 months and 132 (95%) within 1 year. In univariate analyses, peripheral vascular disease, diabetes, and the combination were all associated with the risk of recurrence; age (>70 years) was not. For osteomyelitis due to Staphylococcus aureus, the relative risk of recurrence, using a Cox regression model, was 0.8 for ceftriaxone (95% confidence interval [CI]: 0.4 to 1.5; P = 0.53), 1.1 for cefazolin (95% CI: 0.5 to 2.2; P = 0.80), and 2.5 for vancomycin (95% CI: 1.1 to 5.6; P = 0.04), as compared with the use of a penicillinase-resistant penicillin.. Diabetes and peripheral vascular disease are important factors in determining the prognosis of patients with osteomyelitis, but age is not. Almost all recurrences of osteomyelitis occur within 1 year. Recurrence rates with osteomyelitis associated with S. aureus appear to be higher with the use of vancomycin, whereas ceftriaxone and cefazolin appear to be similar to penicillinase-resistant penicillins.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Amputation, Surgical; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Child; Diabetes Complications; Female; Humans; Infusions, Intravenous; Male; Medical Records; Middle Aged; Osteomyelitis; Outcome Assessment, Health Care; Penicillins; Peripheral Vascular Diseases; Proportional Hazards Models; Recurrence; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Survival Analysis; Vancomycin; Washington

Topics: Anti-Bacterial Agents; Atlanto-Axial Joint; Ceftriaxone; Epidural Abscess; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radiography; Spinal Diseases; Syndrome

Topics: Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Diabetes Mellitus; Duplicate Publications as Topic; Humans; Osteomyelitis; Penicillins; Peripheral Vascular Diseases; Staphylococcal Infections

Between August 1995 and December 1999, sixty patients with chronic osteomyelitis had the effluent from the discharging sinuses and bone biopsies cultured aerobically and anaerobically. 47 positive isolates were obtained and the organism commonly isolated both in the single- and two-organism isolates was Staphylococcus aureus. The sensitivity patterns of these isolates were carried out with the available antibiotic discs. 30 per cent of the organisms isolated were sensitive to ceftriaxone (Rocephine) and gentamycin.

Topics: Anti-Bacterial Agents; Biopsy; Ceftriaxone; Chronic Disease; Drug Resistance, Bacterial; Female; Fractures, Bone; Gentamicins; Hospitals, University; Humans; Incidence; Male; Microbial Sensitivity Tests; Nigeria; Osteomyelitis; Patient Selection; Prospective Studies; Sex Distribution; Staphylococcal Infections; Staphylococcus aureus; Wounds, Nonpenetrating

Chronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two-staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. An important modification of the procedure was the substitution of gentamicin beads (Septopal) with ceftriaxone-polymethylmethacrylate (PMMA) beads at the saucerised segment of bone at the first stage. Thirty-four patients with chronic osteomyelitis had the two-stage Belfast operation in 35 long bones; of these, 32 patients had ceftriaxone-PMMA antibiotic beads inserted at the saucerised segment of bone at the first stage, while the other two patients had gentamicin beads inserted. One of the two patients who had gentamicin beads had a residual collection of pus at second stage surgery but, following a repeat debridement, the cavity was rid of infection. There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone-PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone-PMMA beads rather than gentamicin beads.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bone Cements; Ceftriaxone; Child; Child, Preschool; Chronic Disease; Combined Modality Therapy; Delayed-Action Preparations; Developing Countries; Drug Delivery Systems; Drug Implants; Female; Humans; Male; Microspheres; Middle Aged; Osteomyelitis; Polymethyl Methacrylate

We report an unusual child with sickle cell disease, in which osteomyelitis of the sternum and clavicle was diagnosed at the same time. The standard x-ray failed to demonstrate the lesion. Magnetic resonance imaging was very helpful in locating the site and degree of involvement. We recommend the use of magnetic resonance imaging to delineate such findings.

Topics: Anemia, Sickle Cell; Ceftriaxone; Child; Clavicle; Combined Modality Therapy; Drainage; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Osteomyelitis; Severity of Illness Index; Sternum; Treatment Outcome

Nonconvulsive status epilepticus is an unusual complication of cephalosporin therapy, with only a few isolated cases reported.. We reviewed the clinical and electroencephalographic (EEG) characteristics of 10 patients with renal failure in whom developed alteration of consciousness without convulsions associated with continuous epileptiform EEG activity while being treated with cephalosporins.. Nonconvulsive status epilepticus developed in 5 men and 5 women, with a mean (+/- SD) age of 69 +/- 14 years, while receiving intravenous cephalosporins (ceftriaxone, 2 patients; ceftazidime, 2; and cefepime, 6). All patients had renal failure; 1 also had hepatic failure. Patients presented with progressive disorientation or agitation, sometimes associated with mild facial or limb myoclonus, that had begun 1 to 10 days (mean, 5 +/- 2 days) after starting cephalosporin treatment. The EEG showed continuous or intermittent bursts of generalized, high-voltage, 1 to 2 Hz sharp wave activity or sharp and slow wave activity that resembled, but could be differentiated from, the triphasic waves seen in metabolic encephalopathies. Intravenous clonazepam suppressed the epileptiform activity completely in 5 patients and partially in the other 5. Cephalosporins were withdrawn, and antiepileptic therapy was started for all patients. All patients improved, 2 in less than 24 hours and the remainder within 2 to 7 days.. Cephalosporins can cause nonconvulsive status epilepticus in patients with renal failure. The clinical picture is difficult to differentiate from a that of metabolic encephalopathy unless an EEG is obtained. Physicians should be aware of this potentially dangerous complication.

Topics: Adult; Aged; Aged, 80 and over; Brain; Cefepime; Ceftazidime; Ceftriaxone; Cephalosporins; Electroencephalography; Female; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Middle Aged; Osteomyelitis; Renal Insufficiency; Respiratory Tract Infections; Status Epilepticus

A case report.. To report and discuss a case of pneumococcal vertebral osteomyelitis with meningitis in a previously healthy 51-year-old immunocompetent woman who presented with acute onset lower back pain.. To the authors' knowledge, pneumococcal vertebral osteomyelitis with meningitis in an immunocompetent person with no other predisposing factor has not been reported previously.. The patient was diagnosed to have pneumococcal meningitis 10 days after the onset of acute and severe lower back pain. Significant improvement of clinical symptoms from meningitis was achieved with appropriate antimicrobial treatment. Lumbar CT and MRI scans were performed on persistence of fever and lower back pain. Loss of height and peridiscal inflammation at L3-L4 and epidural and bilateral psoas abscesses were detected.. Diagnosis of pneumococcal vertebral osteomyelitis was established after evaluation of the material obtained from CT-guided aspiration of the psoas abscess and biopsy of the L3 body. With appropriate antimicrobial treatment, the patient's complaints resolved completely.. To the authors' knowledge, this is the first reported case of pneumococcal vertebral osteomyelitis with meningitis.

Topics: Ceftriaxone; Cephalosporins; Female; Humans; Low Back Pain; Lumbar Vertebrae; Meningitis; Middle Aged; Osteomyelitis; Pneumococcal Infections; Spondylolisthesis; Streptococcus pneumoniae; Tomography, X-Ray Computed

Ceftriaxone, although less active than standard antistaphylococcal agents, is potentially useful in the treatment of osteomyelitis. Thirty-one patients with osteomyelitis due to Staphylococcus aureus were identified, 22 of whom were treated with ceftriaxone and 9 with other agents. Of those patients treated with ceftriaxone, 17 were cured; all treatment failures were associated with chronic osteomyelitis and continued presence of necrotic bone or infected hardware. It is concluded that ceftriaxone is effective in the ambulatory treatment of S. aureus osteomyelitis.

Topics: Adult; Aged; Ambulatory Care; Ceftriaxone; Cephalosporins; Humans; Middle Aged; Osteomyelitis; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Female; Humans; Infant; Magnetic Resonance Imaging; Meningitis, Bacterial; Osteomyelitis; Sacrum; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed; Vancomycin

Topics: Biopsy, Needle; Calcaneus; Ceftriaxone; Cefuroxime; Clindamycin; Drug Therapy, Combination; Female; Humans; Infant; Male; Neisseriaceae; Neisseriaceae Infections; Osteomyelitis

A model was developed to identify and compare the local wound factors that induce acute osteomyelitis in a prospective, controlled investigation. When compared with wounds containing either virulent bacteria or dead bone, statistical analysis disclosed a significant increase in the incidence of osteomyelitis when virulent bacteria and dead bone were combined. The incidence of osteomyelitis in wounds containing an inoculated, hematoma-filled dead space was significantly less when compared with wounds containing dead bone and virulent bacteria. The incidence of osteomyelitis is significantly less when a nonvirulent strain of bacteria is substituted for a virulent strain. Although rigid internal fixation increased the incidence of osteomyelitis to 100% and long-term antibiotic therapy decreased the incidence, these changes were not statistically significant. These data allow the authors to predict the relative risk of osteomyelitis when these wound factors are present. The prevention of osteomyelitis depends on the clinical identification and modification of these local wound factors.

Topics: Acute Disease; Animals; Ceftriaxone; Models, Biological; Osteomyelitis; Prospective Studies; Rabbits; Risk; Staphylococcus aureus; Virulence; Wounds and Injuries

Topics: Aged; Ceftriaxone; Female; Humans; Lumbar Vertebrae; Osteomyelitis; Penicillin Resistance; Pneumococcal Infections; Spondylitis; Streptococcus pneumoniae

A 4-year-old girl with Legg-Calve Perthes' disease and immunoglobin G1 subclass deficiency developed osteomyelitis of the proximal femur and septic arthritis of the hip secondary to Haemophilus influenzae, type f. This microorganism is a rare cause of invasive infections in children, primarily of the central nervous system (CNS) and respiratory track. It has not previously been associated with bone and joint infections.

Topics: Arthritis, Infectious; Ceftriaxone; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Femur; Haemophilus Infections; Haemophilus influenzae; Hip Joint; Humans; Osteomyelitis; Ticarcillin

Since 1981 our physicians' office has developed an outpatient parenteral antibiotic therapy programme which has shown advantages in patient care and provided significant cost savings. While we were able to provide any parenteral antibiotic available, the mainstay of our programme was ceftriaxone because of its broad range of activity, safety, and once-daily administration. Two hundred and ninety cases of outpatient ceftriaxone usage were recorded between January 1989 and March 1990. Ceftriaxone was found to be most useful for bone, soft tissue, and gynaecological infections. Not only was it highly clinically successful, but it was safe to use in the twice-weekly monitoring parameters we routinely perform in our office. The use of ceftriaxone alone during the 15-month period accounted for savings of over US $1.2 million compared to the cost of hospitalization during this period.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Cost-Benefit Analysis; Drug Therapy, Combination; Female; Humans; Infant; Injections, Intravenous; Male; Middle Aged; Osteomyelitis; Self Administration

We describe a 19 year old woman with systemic lupus erythematosus on corticosteroid therapy, who developed bilateral, multiple, gas-forming Salmonella enteritidis leg abscesses and osteomyelitis mimicking deep vein thrombosis. The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone, followed by prolonged oral pefloxacin. This rare case of gas-producing S. enteritidis emphasizes the difficulty in diagnosing such complications in active systemic lupus erythematosus.

Topics: Abscess; Adult; Ceftriaxone; Drainage; Female; Humans; Leg; Lupus Erythematosus, Systemic; Osteomyelitis; Pefloxacin; Salmonella enteritidis; Salmonella Infections

Topics: Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Elbow Joint; Humans; Infant; Male; Neisseria meningitidis; Osteomyelitis; Penicillins; Prognosis

Topics: Ceftriaxone; Citrates; Citric Acid; Humans; Male; Middle Aged; Osteomyelitis; Pneumonia; Radionuclide Imaging

Topics: Adult; Ceftriaxone; Haemophilus Infections; Humans; Male; Osteomyelitis; Spinal Diseases

Topics: Adult; Ceftriaxone; Female; Humans; Infusions, Intravenous; Mandibular Diseases; Osteomyelitis; Patient Discharge; Patient Education as Topic

Selected patients with community-acquired infections can be discharged from the hospital, when afebrile and stable, with parenteral antibiotic therapy continued on an ambulatory basis. This therapy is currently possible because of the availability of long-acting cephalosporins that can be administered once daily, often with substantial reductions in hospital costs. Cefonicid and ceftriaxone both have sufficiently long half-lives and either may be administered intramuscularly once daily. Their antibacterial spectra encompass many of the pathogens encountered in community-acquired infections of the lower respiratory tract, skin and soft tissue, bone, and urinary tract. Ceftriaxone, a third-generation cephalosporin, has a broader spectrum than the second-generation agent cefonicid. Ceftriaxone should generally be reserved for the treatment of gonococcal disease and of community- or hospital-acquired infections due to organisms resistant to the narrower-spectrum and less expensive long half-life agent cefonicid.

Topics: Ambulatory Care; Cefamandole; Cefonicid; Ceftriaxone; Costs and Cost Analysis; Humans; Osteomyelitis; Pneumonia; Pyelonephritis; Skin Diseases, Infectious

The therapy of osteomyelitis utilizing 481 courses of intravenous antibiotics in outpatients was analyzed to identify the types of bone infection most frequently treated by this form of therapy. The efficacy of this form of treatment is also discussed.

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoperazone; Ceftriaxone; Clindamycin; Female; Humans; Male; Osteomyelitis; Outpatient Clinics, Hospital

Empiric treatment of serious Salmonella infections has been complicated by the emergence of strains resistant to multiple antimicrobial agents, including ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole. Recent reports suggest that the third-generation cephalosporins may be effective therapy for Salmonella infections. This report describes a case of antibiotic-resistant Salmonella heidelberg prosthetic hip infection successfully treated with prosthesis removal and once-daily ceftriaxone. Tube dilution sensitivity testing of the organism demonstrated minimal inhibitory and minimal bactericidal concentrations of 0.12 microgram/ml. Serum bactericidal activity, 30 minutes after infusion, was inhibitory and bactericidal at 1:512. It is concluded that the favorable preliminary results reported in the literature and the outcome in this patient suggest that the third-generation cephalosporins may be effective therapy for Salmonella infections and should undergo clinical trials.

Topics: Adult; Ceftriaxone; Drug Resistance, Microbial; Equipment Contamination; Hip Prosthesis; Humans; Male; Microbial Sensitivity Tests; Osteomyelitis; Prosthesis Failure; Salmonella; Salmonella Infections

Cefonicid (Monocid) and ceftriaxone (Rocephin) are long half-life cephalosporins that may be used for serious infections in the outpatient setting. They may be used as an extension of initial hospital treatment, or therapy can be initiated and completed in many cases with the patient remaining at home. Sufficient clinical experience exists with both ceftriaxone and cefonicid to recommend these agents for selected patients having pyelonephritis, osteomyelitis, or soft tissue infections. Cefonicid, perhaps in combination with erythromycin, will provide excellent coverage for complicated community-acquired pneumonias. Ceftriaxone is effective as single-dose therapy for even complicated gonococcal infections. The use of long half-life cephalosporins in ambulatory practice may result in substantial cost savings for certain patients.

Topics: Ambulatory Care; Bacterial Infections; Cefamandole; Cefonicid; Ceftriaxone; Cellulitis; Cephalosporins; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Osteomyelitis; Pyelonephritis; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

Topics: Amoxicillin; Bacteria; Cefotaxime; Ceftriaxone; Child; Humans; Osteomyelitis; Penicillin Resistance; Peritonitis; Premedication; Surgical Wound Infection; Urinary Tract Infections; Wounds and Injuries

The combined medical-surgical approach to therapy for osteomyelitis requires patients to receive intravenous antibiotics three to six times daily for 4 to 6 weeks after initial surgical debridement. The greatly extended half-life of the new cephalosporin, ceftriaxone (6 to 8 hours), enabled its intravenous administration once or twice daily to 76 patients for the treatment of osteomyelitis. Cure or improvement was noted in 66 of the 76 patients (87 percent). Most of the failures occurred in the group of patients with osteomyelitis complicated by vascular insufficiency. The once or twice daily dosing possible with ceftriaxone was particularly advantageous for permitting highly cost-effective at home therapy for 42 of the 76 patients.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Combined Modality Therapy; Debridement; Drug Administration Schedule; Female; Hospitalization; Humans; Male; Middle Aged; Osteomyelitis; Prognosis; Recurrence; Self Administration; Vascular Diseases

Ceftriaxone is an investigational cephalosporin with a half-life of five to eight hours. In an uncontrolled study, we evaluated its efficacy and safety in 30 pediatric and 12 young adult patients with serious bacterial infections. This agent was administered to children at a dosage of 50 to 75 mg/kg/day intravenously in two divided doses. Those with CNS infections received 100 mg/kg/day. In adults, the dosage was 1 g either once or twice daily. The diseases we treated included pneumonia (17), sepsis (eight), ventriculoperitoneal shunt infections (three), osteomyelitis (three), brain abscess (two), peritonitis (two), and miscellaneous (seven). Clinical cures were achieved in all cases, although one child with cystic fibrosis and Pseudomonas pneumonia had persistent colonization in his sputum. No serious side effects were observed. Although not the agent of choice for many of these pathogens, ceftriaxone appears to represent an important alternative to therapy.

Topics: Bacteria; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Osteomyelitis; Pneumonia