Background: Multi-drug resistant (MDR) pathogens are of increasing concern in clinical medicine. Patients with prosthetic joints as well as those with fractures are at risk of contracting infections. Extent and frequency of infections with MDR bacteria in patients with osteoarticular infections in Germany are largely unknown. Methods & Materials: A large case series of patients admitted to a specialized septic surgery ward in a tertiary referral center was analyzed for the presence of MDR bacteria in joint fluids, tissue samples and swabs taken from purulent secretions during surgery. Results: Patients admitted in 2014-2016 with osteoarticular infections with and without prosthetic material and positive microbiological samples were included in the analysis. In 274 individuals 554 microbiological samples were obtained which disclosed 656 pathogens. MDR bacteria were isolated in 43/656 (6.6%). The distribution of MDR pathogens comprised MRSA in 22 (3.4%) cases, VRE in 12 (1.8%), ESBL-producing Gram-negative bacteria (E. coli and K. pneumoniae) in 6 (0.9%), and non-fermenter with peculiar resistance patterns (MDR-Stenotrophomonas maltophilia, Colistin-resistant P. aeruginosa) in 3 (0.5%). Carbapenemase-producing bacteria were not retrieved. The numbers of detected MDR pathogens increased over the years (5.8% in 2014, 6.8% in 2015, and 8.3% in 2016) albeit not reaching statistical significance. Conclusion: MDR pathogens were frequently found in our large case series. Gram-positive pathogens (MRSA, VRE) are predominating the spectrum. Difficult-to-treat Gram-negative bacteria were rarely seen.
Background: Anthroponotic cutaneous Leishmaniasis is a common cause of ulcerative lesions and disfiguring scarring among children in Afghanistan. Most lesions occur on the face, and are commonly caused by the trypanosome protozoan parasite Leishmania Tropica, transmitted by the bite of an infected sandfly (Phlebotomus Sergenti). This study compared the effectiveness of a single localized treatment with thermotherapy to five days of intralesional administration of glucantime for the treatment of cutaneous leishmaniasis.Methods: Randomized Controlled Trial: Results: Three hundred and eighty two patients with cutaneous leishmaniasis were randomly assigned to the two treatment groups and followed for six months. The cure rate for the thermotherapy group was 82.5%, compared to 74% in the glucantime group. Conclusion:The study team concluded that a single localized treatment with thermotherapy was more effective than five days of intralesional administration of Glucantime. Additionally, thermotherapy was more cost effective, with fewer side effects, of shorter duration, and with better patient compliance than intralesional glucantime.
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