scholarly journals Sinus of Valsalva Pseudoaneurysm as a Sequela to Infective Endocarditis

2016 ◽  
Vol 43 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Chin C. Lee ◽  
Robert J. Siegel
Keyword(s):  
Infective Endocarditis ◽  
Antibiotic Therapy ◽  
Recurrent Infection ◽  
Sinus Of Valsalva ◽  
Intravenous Antibiotic ◽  
Severe Aortic Regurgitation ◽  
Coronary Cusp ◽  
Vestibular Toxicity ◽  
Group B

Pseudoaneurysm is an uncommon sequela of infective endocarditis. We treated a 44-year-old man who had an active case of group B streptococcal infective endocarditis of the aortic valve despite no evidence of valvular dysfunction or vegetation on his initial transesophageal echocardiogram. After completing 6 weeks of intravenous antibiotic therapy, the patient developed a sinus of Valsalva pseudoaneurysm and severe aortic regurgitation caused by partial detachment of the left coronary cusp. We used a pericardial patch to close the pseudoaneurysm and repair the coronary cusp. This case shows the importance of routine clinical follow-up evaluation in infective endocarditis, even after completion of antibiotic therapy. Late sequelae associated with infective endocarditis or its therapy include recurrent infection, heart failure caused by valvular dysfunction (albeit delayed), and antibiotic toxicity such as aminoglycoside-induced nephropathy and vestibular toxicity.

Management of complicated shunt infections: a clinical report

2008 ◽  
Vol 1 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Hector E. James ◽  
John S. Bradley
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Protocol ◽  
Shunt Infection ◽  
The Body ◽  
Clinical Report ◽  
Intravenous Antibiotic ◽  
Once Daily ◽  
Intravenous Antibiotic Therapy ◽  
Shunt Infections

Object The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Methods Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3–6 months after therapy was completed. Results A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2–11 years (mean 4.4 ± 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Conclusions Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.

Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure

2007 ◽  
Vol 6 (5) ◽  
pp. 407-411 ◽  
Author(s):  
G. Alexander Jones ◽  
John Butler ◽  
Isador Lieberman ◽  
Richard Schlenk
Keyword(s):  
Blood Loss ◽  
Antibiotic Therapy ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Bleeding Complications ◽  
Vacuum Assisted Closure ◽  
Wound Therapy ◽  
Intravenous Antibiotic ◽  
Spinal Infections

Object Deep infections of the spine are a significant cause of morbidity and death. Such infections complicate 0.7 to 11.9% of spinal procedures. Management includes intravenous antibiotic therapy, debridement and irrigation with primary closure, placement of drains, use of irrigation systems, and/or healing through secondary intention with wound packing. Vacuum-assisted closure (VAC) is a new alternative for treatment of patients with complex postoperative spinal infections. The aim of this study was to investigate the safety of this treatment method in this patient population. Methods The authors reviewed the charts of 16 consecutive patients treated with negative-pressure wound therapy at their institution between 2002 and 2006. All had deep infections of the spine and were treated with surgical debridement and placement of VAC dressings. All infections were postoperative. Members of the infectious disease service were involved in the care of all patients, and all patients received intravenous antibiotic therapy. The authors reviewed operative notes, discharge summaries, and notes from follow-up visits and assessed outcome on the basis of the same records. Three patients were lost to follow up, leaving a group of 13 with follow up of at least 90 days. Two patients experienced bleeding complications related to the continuous negative pressure of the VAC device. In two cases, the infections persisted and required reoperation. In one case, a skin graft was required because of nonhealing granulation tissue. One of the patients with bleeding complications died as a result of delayed complications related to intraoperative blood loss, blood loss via the VAC system, and refusal of a blood transfusion on religious grounds. Conclusions Negative-pressure wound therapy has been employed as a treatment strategy for patients with complex postoperative spinal infections, but little is known of the complications associated with VAC in the spinal surgery patient population. Serious complications, including death, may be associated with use of the VAC system.

Use of structural allografts in spinal osteomyelitis: a review of 47 cases

2000 ◽  
Vol 93 (1) ◽  
pp. 8-14 ◽  
Author(s):  
James M. Schuster ◽  
Anthony M. Avellino ◽  
Frederick A. Mann ◽  
Allain A. Girouard ◽  
M. Sean Grady ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Persistent Infection ◽  
Perceived Risk ◽  
Recurrent Infection ◽  
Content Type ◽  
Hardware Failure ◽  
Spinal Osteomyelitis ◽  
Structural Allografts ◽  
Fine Print

Object. The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]). Methods. Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14–83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 ± 9 months (median 14 months, range 6–45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure. Conclusions. It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.

scholarly journals Posttraumatic Skin and Soft-Tissue Infection due toPseudomonas fulva

2016 ◽  
Vol 2016 ◽  
pp. 1-2 ◽  
Author(s):  
Fernando Cobo ◽  
Gemma Jiménez ◽  
Javier Rodríguez-Granger ◽  
Antonio Sampedro
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Soft Tissue Infection ◽  
Traffic Accident ◽  
Left Thigh ◽  
Species Level ◽  
Tissue Infection ◽  
Intravenous Antibiotic ◽  
Injured Area

We report a case of posttraumatic skin and soft-tissue infection in a patient with a left thigh wound after a traffic accident.Pseudomonas fulvawas isolated from a wound aspirate and was identified to the species level by Maldi-tof. The patient responded to drainage, debridement of wound, and two weeks of intravenous antibiotic therapy. Follow-up after 3 weeks was satisfactory with healthy cover of the injured area.

Lawsonella clevelandensis: an emerging cause of vascular graft infection

2021 ◽  
Vol 14 (2) ◽  
pp. e237350
Author(s):  
Rommel Ramesh ◽  
Mariam Assi ◽  
Zerelda Esquer Garrigos ◽  
Muhammad Rizwan Sohail
Keyword(s):  
16S Rrna ◽  
Antibiotic Therapy ◽  
Surgical Resection ◽  
Vascular Graft ◽  
Graft Infection ◽  
Clinical Diagnostics ◽  
Emerging Pathogen ◽  
Vascular Graft Infection ◽  
Intravenous Antibiotic

Lawsonella clevelandensis, an emerging pathogen, was first described in 2016, and has been implicated in abdominal, breast and spinal abscesses in a limited number of cases. Being a fastidious organism, it is primarily identified with molecular methods. With the incorporation of broad-range PCR testing in clinical diagnostics, L. clevelandensis has been increasingly reported in the literature. We describe a case of a 65-year-old man who presented with bilateral psoas abscesses secondary to aorto-bi-iliac vascular graft infection with L. clevelandensis identified using 16S rRNA/PCR sequencing. The patient underwent surgical resection and replacement of infected graft, followed by 6 weeks of intravenous antibiotic therapy and then chronic suppression with doxycycline and cefadroxil. He was infection-free at last follow-up.

scholarly journals Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Pouya Nezafati ◽  
Mohammad Hassan Nezafati ◽  
Hamid Hoseinikhah
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
Sinus Of Valsalva ◽  
Severe Aortic Regurgitation ◽  
Risk Of Mortality ◽  
Limb Edema

Introduction. Unruptured sinus of valsalva aneurysm (SVA) is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD) and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema.Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD.Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status.Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery.

scholarly journals Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis

2016 ◽  
Vol 4 (2) ◽  
pp. 59-63
Author(s):  
Preeti Sharma ◽  
Goverdhan Dutt Puri ◽  
Harkant Singh ◽  
Bhupesh Kumar ◽  
Ganesh K Munirathinam
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Right Ventricle ◽  
Transesophageal Echocardiography ◽  
Previous History ◽  
Pulmonary Artery Hypertension ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
Severe Aortic Regurgitation

ABSTRACT Introduction Sinus of Valsalva aneurysm (SOVA) may have associated infective endocarditis in which case single aneurysm may drain into adjacent chamber of heart via multiple openings. We report a rare case of congenital SOVA with associated infective endocarditis where intraoperative transesophageal echocardiogram (TEE) helped in localizing two separate openings in the SOVA draining into right ventricle and an associated perforation in the larger rightward cusp of bicuspid aortic valve (BAV) causing severe aortic regurgitation. Case report A 28-year-old male presented with grade III to IV dyspnea with previous history of infective endocarditis. Preoperative transthoracic echocardiogram (TTE) showed calcified BAV with severe aortic valve regurgitation and stenosis, severe tricuspid regurgitation, and pulmonary artery hypertension along with ruptured SOVA arising from right coronary sinus and draining into the right ventricle. Intraoperative TEE confirmed the TTE findings and in addition showed the presence of two jets arising from the SOVA draining into right ventricle, a subaortic membrane, and a perforation in the aortic cusp opening into left ventricle. The ruptured SOVA was repaired using single patch technique and aortic valve was replaced. The completeness of the repair was checked using TEE to exclude failure of closure of additional opening if any and the patient was discharged from hospital after 7 days of uneventful postoperative course. Conclusion Sinus of Valsalva aneurysm may have multiple openings draining into adjacent chamber, particularly if associated with infective endocarditis. Intraoperative TEE plays a crucial role in identification of multiple opening, involvement of adjacent structure, and assessment of completeness of repair. How to cite this article Kumar B, Munirathinam GK, Sharma P, Puri GD, Singh H. Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis. J Perioper Echocardiogr 2016;4(2):59-63.

scholarly journals Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial

2019 ◽  
Vol 78 (8) ◽  
pp. 1114-1121 ◽  
Author(s):  
Ergys Gjika ◽  
Jean-Yves Beaulieu ◽  
Konstantinos Vakalopoulos ◽  
Morgan Gauthier ◽  
Cindy Bouvet ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antibiotic Therapy ◽  
Median Number ◽  
Surgical Drainage ◽  
Cure Rate ◽  
Median Length ◽  
Bacterial Arthritis ◽  
Intravenous Antibiotic ◽  
Registration Number

ObjectiveThe optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown.MethodsWe conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months.ResultsWe enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions.ConclusionsAfter initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis.Trial registration numberNCT03615781.

scholarly journals The novel use of oral antibiotic monotherapy in prosthetic valve endocarditis caused by Finegoldia magna: a case study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Siobhan Chien ◽  
David Gorman ◽  
Charilaos-Panagiotis Koutsogiannidis ◽  
Ramanish Ravishankar ◽  
Ganesh Kamath ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Antibiotic Therapy ◽  
Prosthetic Valve ◽  
Effective Means ◽  
Prosthetic Valve Endocarditis ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy

Abstract Background Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis. Case presentation This case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up. Conclusions This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.

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