Amebiasis can be considered the most aggressive disease of the human intestine, responsible in its invasive form for clinical syndromes, ranging from the classic dysentery of acute colitis to extra-intestinal disease, with emphasis on hepatic amebiasis, unsuitably named amebic liver abscess. Found worldwide, with a high incidence in India, tropical regions of Africa, Mexico and other areas of Central America, it has been frequently reported in Amazonia. The trophozoite reaches the liver through the portal system, provoking enzymatic focal necrosis of hepatocytes and multiple micro-abscesses that coalesce to develop a single lesion whose central cavity contains a homogeneous thick liquid, with typically reddish brown and yellow color similar to "anchovy paste". Right upper quadrant pain, fever and hepatomegaly are the predominant symptoms of hepatic amebiasis. Jaundice is reported in cases with multiple lesions or a very large abscess, and it affects the prognosis adversely. Besides chest radiography, ultrasonography and computerized tomography have brought remarkable contributions to the diagnosis of hepatic abscesses. The conclusive diagnosis is made however by the finding of Entamoeba histolytica trophozoites in the pus and by the detection of serum antibodies to the amoeba. During the evolution of hepatic amebiasis, in spite of the availability of highly effective drugs, some important complications may occur with regularity and are a result of local perforation with extension into the pleural and pericardium cavities, causing pulmonary abscesses and purulent pericarditis, respectively The ruptures into the abdominal cavity may lead to subphrenic abscesses and peritonitis. The treatment of hepatic amebiasis is made by medical therapy, with metronidazole as the initial drug, followed by a luminal amebicide. In patients with large abscesses, showing signs of imminent rupture, and especially those who do not respond to medical treatment, a percutaneous drainage must be performed with either ultrasound or computerized tomography guidance. Surgical drainage by laparotomy is reserved to patients with secondary infections.
Background Orthopedic implant-associated surgical site infection (SSI) is a severe complication presenting a treatment challenge. Recently, Gram-negative bacteria orthopedic infections have become a global concern.Objectives:To describe the bacterial profile of orthopedic implant-associated Gram-negative infections and specific outcome of Acinetobacter baumannii infections.Methods A single-center, retrospective cohort study analyzing the infection control database on the year 2016. Cases selected were those osteosynthesis or prosthetic joint, which evolved with SSI and Gram-negative bacterial growth in bone tissue or periprosthetic cultures.ResultsIn 2016, 4001 clean surgeries with orthopedic implant placement were performed; of which 84 fulfillled the criteria for SSI, according to CDC/NHSH definitions (54 cases of open fracture reduction, 24 of hip arthroplasty, five of knee arthroplasty). Main agent of infections was Staphylococcus aureus (29.9%); Gram-negative bacteria however were responsible for 57.3% of infections (Enterobacter ssp. 22.4%; Acinetobacter baumannii 14.9%; Klebsiella pneumoniae 10%; Pseudomonas aeruginosa 10%). Among them, 100% Enterobacter ssp. were sensitive to carbapenems and 75% to ciprofloxacin. Klebsiella pneumoniae showed sensitivity to carbapenems in 85.7%, Pseudomonas aeruginosa showed sensitivity in 85.7% to carbapenems and 100% to ciprofloxacin. However, Acinetobacter baumannii showed the least favorable profile amongst Gram-negatives since only 12.5% of strains were sensitive to carbapenems, 28.6% to Ampicilin-sulbactam, 22.2% to ciprofloxacin, while showing 100% sensitivity to polymyxins. From 13 patients in whom Acinetobacter baumannii was isolated, none presented sepsis related to this infection, yet four of them died as result of hospitalization-related complications (30.7% mortality rate). Among these deaths, two were related to total hip arthroplasty, one to knee arthroplasty and one to open fracture fixation. Among the survivors, two remain in antimicrobial use and seven showed remission/cure.Conclusion SSI caused by carbepenem-resistant Acinetobacter baumannii represents great impact on morbi-mortality in patients who undergo surgery with placement of orthopedic implants.Disclosures All authors: No reported disclosures.
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