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M E Falagas

Publications and source records attributed to M E Falagas.

At least 37 records · Page 2Linked to original sources
PubMed2005

Perioperative anti-infective prophylaxis with teicoplanin compared to cephalosporins in orthopaedic and vascular surgery involving prosthetic material.

A meta-analysis of randomised controlled trials evaluated the effectiveness and safety of teicoplanin compared to first- or second-generation cephalosporins for perioperative anti-infective prophylaxis in orthopaedic and vascular surgery involving prosthetic material. No differences were found between teicoplanin and cephalosporins with respect to the development of infection at the site of surgery or in remote areas of the body. In addition, there were no significant differences in reported adverse effects or mortality. These findings indicate that both regimens are equally effective in preventing post-operative infections in orthopaedic and vascular surgery involving prosthetic materials.

Anti-Infective Agents↗
PubMed2005

Irrigation with antibiotic-containing solutions for the prevention and treatment of infections.

Administration routes for antimicrobial agents used in clinical practice include the topical, inhaled, enteral and parenteral routes. An antibiotic administration route used frequently worldwide, although not well-studied, involves the irrigation of wounds with antibiotic-containing solutions for the prevention and treatment of infections. This review considers the data available from various experimental and clinical studies in order to provide an update on the use of antibiotic-containing solutions in modern clinical practice. Although irrigation with antibiotic-containing solutions has been suggested to be beneficial in the prevention or treatment of infections in several settings and patient populations, no firm, evidence-based recommendations can be made regarding its use until additional data from well-designed, randomised clinical trials become available. Current exceptions include empyema following lobectomy, or pneumonectomy and pyocystis (vesical empyema), since irrigation with solutions containing antimicrobial agents seems to be a crucial component of the management of these conditions.

Anti-Bacterial Agents↗
PubMed2005

Association between Wegener's granulomatosis and increased antithyroid antibodies: report of two cases and review of the literature.

We report two patients with severe manifestations of Wegener's granulomatosis, who also had significantly increased antithyroid antibodies. Auto-immune reaction against various human tissue antigens probably explains the association between increased anti-neutrophil cytoplasmic and antithyroid antibodies. The clinicians should include thyroid function and antithyroid antibody tests in the laboratory work up of the patients with Wegener's granulomatosis.

Adult↗
PubMed2005

Effect of aerosolized colistin on multidrug-resistant Pseudomonas aeruginosa in bronchial secretions of patients without cystic fibrosis.

We performed a limited microbiological study to examine the effect of aerosolized colistin (1 million international units every 8 hours) on the colonization of the respiratory tract with Pseudomonas aeruginosa of five intubated, mechanically ventilated patients in the Intensive Care Unit (ICU). No adverse or side effects of the administered aerosolized colistin were reported. The microbial counts of Pseudomonas aeruginosa prior to the use of aerosolized colistin, as well as during the second, fourth, sixth, and eighth day after the use of the drug were measured. The results of this preliminary study suggest that aerosolized colistin was effective in reducing quickly the microbial counts and eliminating microbial growth of Pseudomonas aeruginosa by the sixth day of use in all studied patients.

Administration, Inhalation↗
PubMed2004

Usual interstitial pneumonia associated with cytomegalovirus infection after percutaneous transluminal coronary angioplasty.

An unusual case of cytomegalovirus (CMV) pneumonia in a diabetic patient is presented. The diagnosis was based on typical histopathological findings including intranuclear inclusion bodies combined with molecular identification of CMV in tissue specimens. The possibility of CMV reactivation associated with a previous cardiac procedure, which led to the development of usual interstitial pneumonia, is discussed. Clinicians should be aware of CMV-associated severe bilateral pneumonia developing after cardiac procedures even in non-transplant patients. The correct diagnosis depends on clinical awareness in the appropriate setting along with proof of viral infection.

Aged↗
PubMed2004

Recurrent omphalitis in adults.

Recurrent omphalitis is seen more frequently in children, but clinicians world-wide are occasionally challenged by cases of recurrent omphalitis in adults. Apart from folliculitis and infections associated with pilonidal cysts and piercing of the umbilical area, the clinician should consider the possibility of infected remnants of the allantois or the omphalomesenteric (vitelline) duct in adult patients with recurrent omphalitis. Imaging tests such as ultrasound and computed tomography scan frequently help to identify the exact cause of recurrent omphalitis. The combined surgical and medical management usually leads to cure of the problem.

Adult↗
PubMed2004

Munchausen's syndrome presenting as severe panniculitis.

Factitious disorders may trouble any physician during his/her career. A considerable number of cases of Munchausen's syndrome (self-induced disorder) are misdiagnosed in clinical practice. A 36-year-old woman was admitted to our hospital because of fever and abdominal pain. Physical examination showed signs of inflammation of the abdominal wall, and histological examination revealed severe panniculitis. We investigated various aetiologic factors that could probably be related to fat necrosis, but we found no explanation of the phenomenon until we verified the diagnosis of Munchausen's syndrome. 2 years later, the patient underwent surgery for removal of needles, which she herself had deliberately located under her skin. High index of suspicion and physician's persistence are necessary to make the correct diagnosis in the various protean manifestations of Munchausen's syndrome.

Acute Disease↗
PubMed2004

Vaccination against typhoid fever in travellers: a cost-effectiveness approach.

Analysis of data on the incidence of typhoid fever and the costs of vaccination of travellers to the developing world indicates that vaccination may not be cost-effective for travel to countries with a moderate-to-high endemicity. It may be reasonable to selectively vaccinate travellers to countries with a very high incidence of typhoid fever, and particularly those who are visiting relatives or who will be in close contact with the local population. Vaccination of travellers on standard tourist itineraries is probably not necessary. The basic preventative measure for typhoid fever should be the avoidance of potentially contaminated food and drink.

Cost-Benefit Analysis↗
PubMed2001

Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: case report and review of the literature.

STUDY DESIGN: Report of a patient with an epidural abscess after halo pin intracranial penetration at the site of a previous cranioplasty. OBJECTIVES: To report a rare case of intracranial penetration at the site of a previous cranioplasty associated with epidural abscess, and to discuss the diagnostic and therapeutic approach to its management. SUMMARY OF BACKGROUND DATA: The most serious complications associated with use of halo device occur when pins penetrate the inner table of the skull, resulting in cerebrospinal fluid leak and rarely in an intracranial abscess. However, no mention of intracranial halo pin penetration at the site of a previous cranioplasty was found in the literature. METHODS: A 64-year-old man with ankylosing spondylitis had a halo vest placed for management of a fracture dislocation through the C5-C6 intervertebral disc space associated with left C6 radiculopathy. One week later, the patient experienced fever and headache associated with pain, redness, and drainage at the site of the insertion of the left posterior pin. Computed tomography of the brain showed a 1.5-cm intracranial penetration of the halo pin through a previous cranioplasty of the temporal bone, associated with epidural abscess and cerebral edema in the left temporoparietal lobe. The pins and the halo vest were removed, the pin site was cleaned, and a Philadelphia cervical collar was applied. Staphylococcus epidermidis grew on the culture of drainage from the pin site. The patient started immediate intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 2 additional weeks. RESULTS: The patient had gradual improvement of his symptoms within the first 48 hours. At the latest follow-up visit, he had fully recovered and his fracture had healed. CONCLUSIONS: The halo device should not be used for patients with a previous cranioplasty, especially if the pins cannot be inserted at other safe areas of the skull. A thorough medical history and physical examination of the skull are important before the application of a halo device. Computed tomography of the skull may be necessary before elective halo application for patients with concomitant head trauma, confusion, or intoxication and for patients with a previous cranioplasty to ascertain the safest pin sites.

Anti-Bacterial Agents↗
PubMed2000

Bacteroides, Prevotella, and Porphyromonas species: a review of antibiotic resistance and therapeutic options.

Recent basic and clinical research efforts have shed more light on the taxonomy, microbiology, epidemiology, antimicrobial susceptibility and treatment of Bacteroides, Prevotella, and Porphyromonas species. Of all anaerobic bacteria, Bacteroides is the most frequently isolated pathogen from clinical specimens, including blood. Bacteroides, Prevotella and/or Porphyromonas species have been isolated from clinical specimens in cases of infection from almost all anatomic sites. Several multicentre surveys have documented an alarming gradual increase of resistance rates of Bacteroides, Prevotella and Porphyromonas species worldwide. Antimicrobial agents active against >99% of clinical isolates of Bacteroides are metronidazole, chloramphenicol and carbapenems. Agents active against 95-99% of Bacteroides fragilis isolates are the beta-lactam/beta-lactamase inhibitor combinations. B. fragilis group species other than B. fragilis are more likely to be resistant to beta-lactam/beta-lactamase inhibitor combinations than B. fragilis.

Anti-Bacterial Agents↗
PubMed1999

Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer.

BACKGROUND: Because of concern about low specificity, the American College of Physicians guidelines and expert opinion discourage the use of a central venous catheter when obtaining blood for culture for bacteremia or fungemia. However, data on the reliability of cultures done with blood obtained from a central venous catheter are conflicting. OBJECTIVE: To determine the sensitivity, specificity, and positive and negative predictive values of cultures done with blood obtained through a central venous catheter compared with peripheral venipuncture. DESIGN: Retrospective cohort study of hospitalized patients with cancer in whom samples for paired cultures were drawn through a central venous catheter and peripheral venipuncture. SETTING: Tertiary care, university-affiliated medical center. PATIENTS: 185 patients hospitalized on a hematology-oncology ward between August 1994 and June 1996. MEASUREMENTS: Blinded assessments of culture results done by infectious disease experts were used as the gold standard. Sensitivity, specificity, and positive and negative predictive values were compared for culture of blood from central catheters and culture of blood from peripheral venipuncture. RESULTS: Of 551 paired cultures, 469 (85%) were catheter-negative/venipuncture-negative, 32 (6%) were catheter-positive/venipuncture-positive, 17 (3%) were catheter-negative/venipuncture-positive, and 33 (6%) were catheter-positive/venipuncture-negative pairs. For the 82 paired cultures with at least one positive result, blinded determination of true bacteremia or fungemia was made by two infectious disease specialists. For catheter draw compared with peripheral venipuncture, sensitivity was 89% (95% CI, 79% to 98%) and 78% (CI, 65% to 90%) (difference, 11 percentage points [CI, -6 to 28 percentage points]), specificity was 95% (CI, 93% to 97%) and 97% (CI, 96% to 99%) (difference, -2 percentage points [CI, -5 to 0.2 percentage points]), positive predictive value was 63% (CI, 50% to 75%) and 73% (CI, 60% to 86%) (difference, -10 percentage points [CI, -26 to 5 percentage points]), and negative predictive value was 99% [CI, 97% to 100%]) and 98% (CI, 96% to 100%) (difference, 1 percentage point [CI, -0.5 to 3 percentage points]). CONCLUSIONS: In hospitalized hematology-oncology patients, culture of blood drawn through either the central catheter or peripheral vein shows excellent negative predictive value. Culture of blood drawn through an indwelling central venous catheter has low positive predictive value, apparently less than from a peripheral venipuncture. Therefore, a positive result from a catheter needs clinical interpretation and may require confirmation. However, the use of a catheter to obtain blood for culture may be an acceptable method for ruling out bloodstream infections.

Anti-Bacterial Agents↗
PubMed1999

Outcome of transplantation of organs procured from bacteremic donors.

BACKGROUND: Transplantation of organs from donors who are bacteremic is controversial. We examined the outcome of recipients of solid organs from donors with bacteremia and/or fungemia at the time of organ recovery. METHODS: All organ donors from a single organ procurement organization between January 1990 and December 1996 were retrospectively analyzed. We calculated rates of transmission from bacteremic or fungemic donors to their recipients and compared the graft and patient survival rates for recipients of these organs with those for recipients of organs from non-bacteremic donors. RESULTS: There were 95 (5.1%) bacteremic donors from a total of 1775, from whom 212 recipients received organs. Forty-six (48%) of the bacteremic donors had pathogens in their blood. Among the 101 recipients of organs from these, no evidence of transmission could be documented. (0% transmission rate, 95% CI 0-3). The remaining 49 donors had either Staphylococcus epidermidis or other unlikely pathogens recovered from the blood. Examination of the 111 recipients of organs from these donors also found no evidence for transmission (0% transmission rate, 95% CI 0-3). Of the 212 recipients, 193 (91%) received a mean of 3.8+/-2.5 days of antibiotics postoperatively. The 30-day graft and patient survival for recipients of organs from bacteremic donors was not significantly different from recipients of organs from nonbacteremic donors (P = 0.695 for patient survival, and P = 0.310 for graft survival). CONCLUSIONS: Organs transplanted from bacteremic donors do not transmit bacterial infection or result in poorer outcomes. Use of organs from these donors could help increase organ availability.

Adult↗