Chryseobacterium indologenes is a rare opportunistic pathogen causing hospital-acquired infection. We present 4 patients with leukemia associated with C. indologenes infection. Two of the patients, undergoing peripheral blood allogeneic hematopoietic stem cell transplantation (alloHSCT) from human leukocyte antigen-identical sibling donors, died of pneumonia caused by C. indologenes with or without Pseudomonas aeruginosa. Blood infection with C. indologenes was found in the other 2 patients during chemotherapy, 1 of which was a central venous catheter-related bloodstream infection. Both patients were cured with or without the sensitive antibiotic. Three of these 4 isolates were susceptible to trimethoprim-sulfamethoxazole only in vitro. Although C. indologenes has a weak toxicity, it can be lethal for the super-immunocompromised patients, such as those treated with alloHSCT.
Background. Previous study had reported hypercalcemia as a frequent complication (20%) following local use of antibiotic-eluting calcium sulfate (CS) during treatment of periprosthetic joint infections (PJIs). However, whether this complication may occur in patients who receive local CS implantation for management of posttraumatic osteomyelitis (OM) remains unclear. Methods. Between April 2016 and May 2017, we included 55 patients with extremity posttraumatic OM who received local antibiotic-loaded CS therapy. Serum calcium levels were detected preoperatively and on the 1st, 3rd, and 7th postoperative days (PODs). Comparisons were performed regarding serum calcium levels among the four time points and between two different CS volume groups (≤ 20 cc group and > 20 cc group). Additionally, potential associations were examined regarding CS volume and preoperative calcium level with postoperative calcium levels, respectively. Results. Altogether 46 males and 9 females were included, with a median CS volume of 20 cc. Outcomes showed that prevalence of asymptomatic hypocalcemia was more frequent, with 16.4% before surgery and 60%, 53.8%, and 25% on the 1st, 3rd, and 7th PODs, respectively. Hypercalcemia was not found in any patients, at any time point. In addition, significant differences were identified regarding serum calcium levels among different time points, suggesting significantly decreased calcium levels on the 1st (P < 0.001) and 3rd PODs (P < 0.001) and back to near preoperative level on the 7th POD (P = 0.334). However, no statistical differences were observed regarding serum calcium levels between the two CS volume groups at any time points (P > 0.05). Moreover, no significant links were identified between CS volume and postoperative calcium levels (P > 0.05). Serum calcium levels on the 3rd (P = 0.019) and 7th PODs (P = 0.036) were significantly associated with the preoperative calcium level. Conclusions. In contrast to what had occurred in PJI patients, asymptomatic hypocalcemia appeared to be more frequent in this cohort with posttraumatic OM. Hypercalcemia may be an infrequent complication before and after local CS use for the treatment of extremity posttraumatic OM.
Purpose The aim of this study was to retrospectively compare the clinical effects of external dacryocystorhinostomy (EX-DCR) and endoscopic dacryocystorhinostomy (EN-DCR) on recurrent dacryocystitis after EN-DCR. Methods Thirty cases involving thirty eyes with post-EN-DCR recurrent dacryocystitis in our hospital between January 2015 and December 2018 were analyzed retrospectively. All of the patients underwent routine preoperative examination, including probing and irrigation of the lacrimal passage, nasal endoscopy, and maxilla-facial computed tomography scanning. Patients with nasal adhesions, nasal tumors and severe deviation of the nasal septum were excluded. Under general anesthesia, twelve patients underwent EN-DCR, and eighteen patients experienced EX-DCR under general anesthesia. Anti-inflammatory treatment was carried out after surgery for one week. The medical records of all the patients were tracked for one year. Results At the third month, all of the EN-DCR patients achieved good results with unobstructed lacrimal irrigation after removal of the bicanalicular tube stents. Sixteen EX-DCR patients had patency of the lacrimal passage, while two other patients exhibited obstructed lacrimal passage. However, at the twelfth month, ten EN-DCR patients had an obstructed lacrimal passage again, and there were only two patients remaining patency in lacrimal duct with a (success rate of 16.7%). In contrast, among the eighteen EX-DCR patients, fifteen cases achieved success with smooth irrigation of the lacrimal passage with a (success rate of 83.3%). There was a statistically significant difference between the two groups in the success rate for the longer follow-up period. No major intra- or post -treatment complications occurred. Conclusions EX-DCR is effective and safe with a higher success rate for the treatment of recurrent dacryocystitis after EN-DCR and might be considered as a primary compensate therapy for EN-DCR.
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