Septic arthritis due to pseudomonas in heroin addicts

Gifford, DB; Patzakis, Michael J.; Ivler, Daniel; Swezey, RL

doi:10.2106/00004623-197557050-00008

Cited by 75 publications

(14 citation statements)

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“…Some authors reported P aeruginosa as the most common pathogen [7,11,14,18], but others identified S aureus as the most common [2, 4-6, 13, 15]. The recent increase of ORSA infections in patients with IDA highlights the potential for progressive changes in the microbiology of bone and joint infections associated with IDA [3].…”

Section: Discussionmentioning

confidence: 99%

“…The microbiology of bone and/or joint infections in patients with IDA has been reported with considerable variability in the literature. Older studies from the USA evaluating patients up to 1979 identified Pseudomonas aeruginosa as the most common pathogen [7,11,14,18], but more recent studies from the USA and Spain reported Staphylococcus aureus as the most common [2, 4-6, 13, 15]. Oxacillin-resistant S aureus (ORSA) infections are an emerging problem in patients with IDA [3].…”

Section: Introductionmentioning

confidence: 99%

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Microbiology of Bone and Joint Infections in Injecting Drug Abusers

Allison¹,

Holtom²,

Patzakis³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The literature contains variable reports on the causative organisms of osteomyelitis and septic arthritis in patients with injecting drug abuse and on the rate of oxacillin-resistant S aureus. It is important to have a clear notion of the organisms to initiate empiric antimicrobial therapy. Questions/purposes We therefore determined the spectrum of organisms in bone and joint infections in patients who were injecting drug users. Methods We retrospectively reviewed the medical records of 215 patients (154 male, 61 female) with a history of injecting drug abuse and concurrent bone and/or joint infection from 1998 to 2005. The mean age was 43 years (range, 23-83 years). Osteomyelitis was present in 127 of the 215 patients (59%), septic arthritis in 53 (25%), and both in 35 (16%). The lower extremity was most commonly involved (141 cases, 66%), with osteomyelitis of the tibia present in 70 patients (33%) and septic knee arthritis in 30 patients (14%). Results Cultures yielded predominately Gram-positive bacteria: Staphylococcus aureus in 52% and coagulasenegative Staphylococcus in 20%. The proportion of oxacillin-resistant S aureus among S aureus infections increased from 21% in 1998 to 73% in 2005. Gram-negative organisms were present in 19% of infections and anaerobes in 13%. Patients with osteomyelitis had a higher prevalence of polymicrobial infections (46% versus 15%), infections due to Gram-negative organisms (24% versus 9%), and anaerobic infections (19% versus 6%) compared to patients with septic arthritis. Conclusions These findings suggest broad-spectrum empiric antibiotic therapy, including vancomycin, should be considered for bone and joint infections in patients with injecting drug abuse.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microbiology of Bone and Joint Infections in Injecting Drug Abusers

Allison¹,

Holtom²,

Patzakis³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…When followed through 7 years of age, offspring demonstrated hypertension, cardiac hypertrophy, and reduced cardiac functional capacity (20). Later in gestation, betamethasone treatment to the ovine fetus and ewe has demonstrated varying effects, including increased (69), no change (41), and decreased blood pressure (31). Specifically, in regard to gestational nutrient stress, fetuses of mildly undernourished ewes Values are means Ϯ SE.…”

Section: Mechanisms Of Gestational Programmingmentioning

confidence: 99%

Gestational programming: population survival effects of drought and famine during pregnancy

Ross

Desai

2005

American Journal of Physiology-Regulatory, Integrative and Comp

119

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The process whereby a stimulus or stress at a critical or sensitive period of development has long-term effects is termed "programming." Studies in humans and animals convincingly demonstrate that environmental perturbations in utero may permanently change organ structure and metabolism and/or alter homeostatic regulatory mechanisms among the offspring. These programmed changes may be the origins of adult diseases, including cardiovascular disease, obesity, and diabetes. Throughout evolution and development, humans and animals have been exposed to two common environmental stresses, drought and famine. Notably, drought-induced water deprivation is associated with dehydration anorexia and thus a concomitant potential nutrient stress. Our laboratory has performed studies among pregnant rat and sheep in which we simulate drought conditions via maternal dehydration and famine conditions via nutrient restriction. Maternal dehydration results in low-birth-weight offspring, which demonstrate gender-specific plasma hypernatremia and hypertonicity and arterial hypertension. Gestational nutrient restriction also resulted in low-birth-weight offspring. If permitted rapid catch-up growth by nutrient availability, these offspring demonstrate evidence of increased body weight and body fat, and leptin resistance as adults. Conversely, if the catch-up growth is delayed by nutrition restriction, the offspring exhibit normal body weight, body fat, and plasma leptin levels as adults. These studies indicate that osmoregulatory and cardiovascular homeostasis and phenotypic predisposition to obesity may be programmed in utero. Importantly, these results suggest that programming effects may be either potentiated or prevented by interventions during the neonatal period.

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“…The treatment consists of a combination of carbenicillin and gentamycin. Only if there are signs of destruction of the joint on xray or if the patient does not respond to repeated aspiration and systemic chemotherapy is open drainage indicated [49].…”

Section: Arthritis and Osteomyelitismentioning

confidence: 99%

Surgical infections in drug addicts

Kallick

1980

World j. surg.

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Infectious complications are responsible for a majority of the medical and surgical hospital admissions and 15% of the deaths of drug addicts. The most common and serious complication is endocarditis, mostly of the right heart, caused by Staphylococci and/or gram-negative rods. If the endocarditis is caused by the latter group of organisms, early operative intervention with excision of the tricuspid and/or replacement of the mitral and aortic valves is frequently necessary because of poor response to antibiotic treatment. Other complications of generalized sepsis are septic pulmonary emboli, which frequently gives rise to pulmonary abscesses, and splenic abscesses. Infections of the vascular system occur as either suppurative thrombophlebitis or mycotic aneurysms. Soft tissue infections in the form of subcutaneous abscesses, cellulitis, myositis, and necrotizing faseiitis are caused by a mixed flora consisting of gram-positive and gram-negative aerobes and anaerobes. The majority of patients with tetanus seen in large cities are drug addicts. Infections of the skeletal system are typically caused by Serratia marcescens or Pseudomonas, and present as septic arthritis of the sternoclavicular or sacroiliac joints or osteomyelitis of the spine originating from a disc space infection.During the last few years drug abuse has increased to epidemic proportions in the United States and in Europe. Most of the professional and public attention has been directed to the social and psychological aspects of this problem; however, the medical sequelae of intravenous drug abuse contribute significantly to the morbidity and mortality in this

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Septic arthritis due to pseudomonas in heroin addicts

Cited by 75 publications

References 0 publications

Microbiology of Bone and Joint Infections in Injecting Drug Abusers

Microbiology of Bone and Joint Infections in Injecting Drug Abusers

Gestational programming: population survival effects of drought and famine during pregnancy

Surgical infections in drug addicts

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