P yogenic sacroiliac arthritis is a rare entity, and most cases are caused by Staphylococcus aureus. Usually, there are underlying diseases presenting, and in healthy persons it can occur in cases involving sport, over exercise, bike riding and running so on. Laboratory findings and imaging investigation is essential given the mild symptoms presenting for instant fever, and back pain. CT guide for aspiration, culture and sensitivity tests as well as appropriate antibiotics are recommended. This presentation is a case report as an example. Case ReportA 16-year old man, with no underlying disease presented with a history of pain in the left buttock for 2 months. He developed low grade fever and mild left gluteal pain. He was treated with non-steroid anti-inflammatory drugs (NSAID) but did not improve after 2 weeks. He felt more pain and was admitted to hospital. MRI of pelvis revealed evidence of left sacroititis with abscesses collecting at the left ileopsoas muscles. The abscess was drained under guided CT. Pus culture grew Staphylococcus aureus. It was susceptible to all tested antibiotics. The patient was treated with an unknown antibiotic for two weeks before travelling to Bangkok Hospital for a second opinion. The physical findings: he was febrile, with moderate pain at the left sacral area. Laboratory findings revealed a total WBC 3,590 cell/mm3 with Neutrophil 59%, Lymphocyte 34%, ESR 1 hour 71 mm. C-reactive protein was 2.96 mg/L. The plain film of the pelvic bone was unremarkable (Figure 1). No evidence of bone destruction was detected. CT of pelvis revealed bony erosion at subchondral region at left sacroiliac joint with residual abscess collection at left iliacus muscle (Figure 2).He was treated with intravenous Cloxacilin for 2 weeks. The patient clinically improved. No fever was observed and he was able to walk with minimal pain at left pelvic girdle. He was discharged from the hospital with an oral antibiotic for up to 3 months. AbstractPyogenic sacroiliac arthritis is a rare entity. The most common bacterial organism is Staphylococcus aureus. More than 50% of cases have underlying diseases, for instance, trauma, immune deficiency, psoriasis, rheumatoid arthritis, post acupuncture and pelvic inflammation etc. In healthy persons, the arthritis is connected to sport medicine, over exercise, bike riding, and running and so on. Mild and nonspecific symptoms fever, lower back pain, gluteal or hip pain are presented. Radiographic image, compute tomography (CT) and/or magnetic resonance image (MRI) with gadolinium (Gd) study are recommended. Adequate and appropriate antibiotics are the initial treatment. Surgical needle aspiration and drainage is essential in case of no response to antibiotics, and is recommended in chronic form debridement and arthrodesis.
The purpose of this research was to reduce rate of CRBSI at Bangkok Hospital by using 2002 CDC evidence-based guidelines as a preventive of CRBSI. 1 MATERIALS AND METHODS.A target surveillance on CRBSI was conducted in all 4 adult intensive care units at the Bangkok Hospital. The findings were compared with the CDC recommendations. Then we set up a multidisciplinary patient-care project team who applied the CDC guidelines in order to work towards the reduction and eventual prevention of CRBSI's in our hospital.RESULTS. The reduction of CRBSI incidence was observed to be sustainable after the new guidelines were implemented in October 2004. The rate of CRBSI incidence reduced gradually especially in the year of 2010. It approached to zero per 1000 catheter-day. CONCLUSION.Nowadays, all healthcare personnel must take responsibility for preventing nosocomial infection. We has demonstrated that our multidisciplinary team can reduce the infection rates sharply. Catheter Related Blood Stream Infection (CRBSI) is the third most common nosocomial infection. The infection results in higher antibiotic costs, prolonged hospitalization days and is even related to high morbidity and death. [2][3][4] The Centers for Disease Control and Prevention (CDC) of the United States of America has provided evidence-based guidelines for catheter care to reduce Blood Stream Infections (BSI). They refer to recommendations for hand hygiene, 5 maximal sterile personnel protection equipment (PPE), 6, 7 preferred antiseptics for skin preparation, 8, 9 catheter site dressing regimens, 10 the site chosen for catheter placement, 11, 12 etc. In 2004, our Infection Control Committee set up a project aimed at reducing CRBSI at Bangkok Hospital by using the aforementioned 2002 CDC evidence-based guidelines as a preventive of CRBSI. 1 Materials and MethodsCase Definitions for CRBSI including 1. Bacteremia/fungemia in a patient with an intravascular catheter, with at least one positive blood culture obtained from a peripheral vein and clinical manifestation of infections (such as fever, chills, and/or hypotension) but no apparent source for the BSI except for the catheter.
S epsis is an infl ammation syndrome which is caused by severe infection. This severe infl ammation is characterized by vasodilatation, leukocyte accumulation and increased microvascular permeability. The pathophysiology of sepsis is believed to be due to the dysregulation of the infl ammatory response. The human body generates and releases a massive uncontrolled amount of proinfl ammatory mediators into the blood stream which causes cellular and tissue injury. This injury leads to the development of multiple organ dysfunction syndromes (MODS), and causes life-threatening conditions. The normal host response to infection involves the activation of circulating and fi xed phagocytic cells, the generation of proinfl ammatory and anti-infl ammatory mediators. When the body releases massive cytokines beyond the infection site, sepsis occurs. These mediators cause fever, hypotension, acute phase protein response, induction of interleukin 6, coagulation activation, increased endothelial permeability and so on. These large quantities of proinfl ammatory mediators will cause cellular damage and lead to multiple organ failure.In conventional therapy for sepsis, the priority is to eradicate infection by using appropriate antibiotics and surgical interventions, and to initiate supportive care in order to correct physiologic abnormalities such as hypoxemia and hypotension. 1-4 Despite optimal treatment and close monitoring in intensive care units, the mortality rate due to severe sepsis and septic shock is approximately 40% and can exceed 50% in the sickest patient. [5][6][7][8] A study from Nakada TA, et al. 9 in 2008 showed a decrease of interleukin 6 and procalcitonin correlated with survival during sepsis. The innovative idea to reduce proinfl ammatory cytokines led to the development of the extracorporeal blood purifi cation technique. Extracorporeal blood purifi cation can be performed in different ways. The treatment restores the normal balance of the targeted substances within the patient's body.Coupled plasma fi ltration adsorption (CPFA) is a therapeutic extracorporeal blood purifi cation tool combining 3 techniques namely plasma fi ltration, adsorption and hemofi ltration. CPFA is suitable for illnesses involving renal failure together with large molecules, especially if these have a molecular weight close to that of albumin such as infl ammatory substances found in sepsis and in liver failure. The CPFA technique has been performed in animal experimentation and in clinical settings worldwide since 1998. Some CPFA studies have been reviewed (Table 1).
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