Kashif J. Piracha, MD FACP’s Post

Osteomyelitis is a serious bone infection that requires prompt medical attention. Here's an overview: *Definition:* Osteomyelitis is an infection of the bone tissue, usually caused by bacteria, fungi, or other microorganisms. *Types:* 1. Acute osteomyelitis: Sudden onset, typically affecting children and adolescents. 2. Chronic osteomyelitis: Long-term infection, often recurring. 3. Subacute osteomyelitis: Gradual onset, between acute and chronic. *Causes:* 1. Bacterial infections (Staphylococcus aureus, most common) 2. Fungal infections (rare) 3. Viral infections (rare) 4. Trauma or injury 5. Surgery or implants 6. Diabetes 7. Immunocompromised conditions *Symptoms:* 1. Pain or tenderness in the affected bone 2. Swelling, redness, or warmth 3. Fever 4. Chills 5. Fatigue 6. Limited mobility 7. Drainage or pus *Stages:* 1. Stage 1: Infection spreads through bloodstream 2. Stage 2: Infection reaches bone tissue 3. Stage 3: Bone destruction and abscess formation 4. Stage 4: Chronic infection, potential for bone deformity *Diagnosis:* 1. Physical examination 2. Imaging tests (X-rays, CT, MRI) 3. Blood tests (CBC, ESR, CRP) 4. Bone biopsy or aspiration *Treatment:* 1. Antibiotics (IV or oral) 2. Surgery (debridement, drainage, or amputation) 3. Pain management 4. Rest and immobilization 5. Antibiotic therapy (long-term, for chronic cases) *Complications:* 1. Bone deformity or destruction 2. Chronic pain 3. Limited mobility 4. Infection spread (sepsis) 5. Amputation (rare) *Prevention:* 1. Practice good hygiene 2. Manage diabetes 3. Avoid smoking 4. Get prompt medical attention for injuries or infections #snsinstitutions #snsdesignthinkers #snscollegeofphysiotherapy

ANTIBIOTICS PROPHYLAXIS IN SURGERIES #Prophylaxis #Antibiotics #Action • Antibiotic prophylaxis refers to the prevention of infection complications using antimicrobial therapy • Surgical antibiotic prophylaxis is defined as the use of antibiotics to prevent infections at the surgical site. • The antibiotic should be administered ideally 60 minutes minutes before incision in order to achieve relevant tissue concentration. • Single dose is cheaper and does not increase the risk of the developement of bacterial resistance. PROPHYLACTIC antibiotics preferred in Surgeries is mentioned here along with their time before incision.

Catheter associated urinary tract infections (UTIs) are the most common complication of intermittent catheterisation (IC). [1] Damage from repeated catheter use can weaken the urethral defense, increasing the risk of UTIs. Irritation and damage to the soft urethral tissue allows bacteria to colonize the space created between cells causing UTIs. [2,3] A healthy urethra is important in UTI prevention [4] and we care about protecting catheter user's urethral health as much as you do. It’s why we created FeelClean Technology™. GentleCath™ with FeelClean Technology™ is the first and only catheter where the slippery hydrophilic properties are integrated inside the catheter itself rather than having a sticky coating. Learn more about urethral health, the first line of defense and how FeelClean Technology™ provides the solution. https://brnw.ch/21wLgEX [References: 1. Engberg S, Clapper J, McNichol L, Thompson D, Welch VW, Gray M. Current Evidence Related to Intermittent Catheterization: A Scoping Review. J Wound Ostomy Cont Nurs Off Publ Wound Ostomy Cont Nurses Soc. 2020;47(2):140-165. doi:10.1097/WON.0000000000000625 2. Werneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol. 2022;14:109-133. doi:10.2147/RRU.S273663 3. Jacobsen SM, Stickler DJ, Mobley HLT, Shirtliff ME. Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev. 2008;21(1):26-59. doi:10.1128/CMR.00019-07 4. Jafari NV, Rohn JL. The urothelium: a multi-faceted barrier against a harsh environment. Mucosal Immunol. 2022;15(6):1127-1142. doi:10.1038/s41385-022-00565-0]

Source: The FEBS journal Salmonella infection in mice leads to intestinal edema characterized by tense fibronectin fibers. The edema proteome includes antimicrobial factors, the blood clotting system, extracellular matrix (ECM), and protease-protease inhibitor networks. Fibronectin fibers in the edema are tensed despite the presence of proteases that can cleave them. In contrast, fibronectin fibers relax in other areas of the cecal tissue as the infection progresses. The edema also shows the formation of a provisional matrix similar to skin injury and a sparse collagen fiber network. Stretched fibronectin fibers may play a critical role in maintaining tissue integrity. Understanding these processes could help develop diagnostic markers for intestinal disease progression.

Infection is not easy to diagnosis, very difficult and challenging. having WBC and fever is not always key indicator for infection. Here are some important notes to share with you some other critical and serious condition that lead to elevate WBC and developing fever. Problem in diagnosis of an infection: 1-Confabulating Variables: Factors like major surgery, acute myocardial infarction, and corticosteroid therapy can increase WBC count. Unlike infection, these factors don't cause a shift to the left in WBC differential. 2-Drug Effects: Corticosteroids can mimic or mask infection by increasing WBC count and causing mental status changes. They may reduce classic findings of peritonitis or fever, masking symptoms of infection. Dexamethasone used in neurosurgery can delay symptoms of meningitis, potentially misleading diagnosis. 3-Fever: Autoimmune diseases, cancers, and drug fever can cause fever similar to infection. Fever must be carefully evaluated, especially after ruling out infection, autoimmune diseases, and malignancy. Neoplasms may resemble abscesses radiographically, requiring empirical therapy and diagnostic reevaluation

The treatment of musculoskeletal infections (MSIs), including periprosthetic joint infection (PJI) and fracture-related infection (FRI), is complicated by biofilm-related challenges, leading to multiple revision surgeries and high costs. Antimicrobial resistance (AMR) further complicates the issue, increasing morbidity and healthcare expenses. Novel antibacterial strategies are urgently needed, with phage therapy endorsed by the World Health Organization as a promising approach. Despite milestones in phage therapy's evolution, challenges like study design variability and phage selection persist. Efforts to improve efficacy include personalized phage therapy and combination with antibiotics. Addressing regulatory barriers, standardizing protocols, and conducting high-quality trials are crucial for establishing phage therapy's efficacy in treating MSIs. Initiatives like the PHAGEFORCE study and PHAGEinLYON Clinic programme aim to streamline phage therapy for personalized treatment and data collection to advance its clinical utility in challenging infections.

A case of Feline Infectious Peritonitis (FIP): M is an 11-month-old male Scottish fold who presented to the clinic with pyrexia, lethargy, anorexia, icterus, pale mucous membranes, uveitis and hypopyon. Initial fluid therapy and antibiotic treatment were ineffective at resolving his fever. Abdominal ultrasound showed a characteristic medullary rim sign in both kidneys. M’s A/G ratio was calculated at 0.46 (normal range 0.6-1.5) and GGT levels were measured at 14 IU/L (normal range 1-7). The combination of antibiotic-resistant fever, low A/G ratio, high GGT activity, pale mucous membranes, and a rim sign led to an initial diagnosis of feline infections peritonitis (FIP), which was confirmed by PCR. Treatment was started with GS-5734 (Remdesivir) at 15 mg/kg for one week, and then 10 mg/kg for the following two weeks, diluted in 0.9% saline and given slowly IV over approximately 30 minutes (per Coggins et al. 2022). Ophthalmic prednisolone was prescribed to control uveitis. Fever subsided after only five days of treatment. After reaching an A/G ratio of 0.57, treatment was switched to GS-441524 (with non-effusive disease with CNS signs, 10-12 mg/kg q24h is recommended). The animal received GS-441524 for 50 days as daily subcutaneous injection. Lethargy and hypopyon quickly resolved after initiation of the new treatment. After 50 days on GS-441524, an A/G ratio of 0.67 was achieved and steady weight gain was observed. The animal was sent home with oral GS-441524 tablets, to be administered once daily for two weeks (10 mg/kg). He has since gained more weight, and his A/G ratio has stabilized. Treatment of FIP can be especially challenging for the owner, as it requires a significant financial and time commitment. Hopefully, with the approval of effective medications, dealing with this disease will become easier in the future. Many thanks to Dr. Kiana Rastegar for their cooperation.

🌟 𝐓𝐡𝐞 𝐂𝐫𝐢𝐭𝐢𝐜𝐚𝐥 𝐓𝐢𝐦𝐢𝐧𝐠 𝐨𝐟 𝐀𝐧𝐭𝐢𝐛𝐢𝐨𝐭𝐢𝐜 𝐏𝐫𝐨𝐩𝐡𝐲𝐥𝐚𝐱𝐢𝐬 𝐢𝐧 𝐒𝐮𝐫𝐠𝐞𝐫𝐲 In surgical procedures, timing is everything. Administering antibiotic prophylaxis before surgery rather than after can be the deciding factor in preventing post-surgical soft tissue infections. Here's why: 🚨 Prevention Focused: For effective infection prevention, antibiotics need to be present in the tissue at the moment of contamination. Administering them post-exposure has minimal impact on preventing infections. Why? Let’s break it down: 1️⃣ Hidden Contaminants: When fibrin is deposited during wound closure without prior antibiotic coverage, contaminants become enclosed in areas where antibiotics have poor penetration. 2️⃣ Inflammatory Cascade: Post-wound closure, an ongoing inflammatory response increases hydrostatic pressure near the wound site due to edema. This impedes systemic drugs from accessing the wound space effectively. 💡 The solution? Administering antibiotics before the incision ensures that the drug is in the tissue at the critical point of potential contamination, setting the stage for optimal prevention. 🔗 Let’s prioritize evidence-based practices to improve surgical outcomes and patient safety. #infectionprevention #APIC #infectionprevention #infectionpreventionandcontrol

📃Scientific paper: Risk factors for systemic inflammatory response syndrome after endoscopic lithotripsy for upper urinary calculi Abstract: Background To explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi. Methods This retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020. Results A total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18–4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15–5.82, P = 0.012) were independently associated with SIRS. Conclusion Positive preoperative urine culture and PCNL are independent risk facto... Continued on ES/IODE ➡️ https://etcse.fr/BNb ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

🔍 Understanding Procalcitonin Interpretation in Clinical Practice 🔬 Procalcitonin (PCT) is a valuable biomarker that helps in diagnosing bacterial infections and guiding antimicrobial therapy decisions. Here’s a quick guide to interpreting PCT levels: 🧪 Normal PCT Levels (<0.1 ng/mL): Indicates a low likelihood of bacterial infection. Antibiotic therapy may not be necessary. 🧪 Low to Moderate Levels (0.1–0.5 ng/mL): Suggests a potential bacterial infection but might also be elevated due to other factors like trauma or surgery. Monitor closely and consider the clinical context. 🧪 High Levels (0.5–2.0 ng/mL): Indicates a probable bacterial infection. Antimicrobial therapy may be warranted based on clinical assessment. 🧪 Very High Levels (>2.0 ng/mL): Strongly suggests severe bacterial infection or sepsis. Immediate intervention and antimicrobial therapy are often necessary. 🔑 Key Points to Remember: Always interpret PCT levels alongside clinical signs, symptoms, and other laboratory findings. PCT can guide antibiotic stewardship by helping to avoid unnecessary antibiotic use and reducing antibiotic resistance. Effective PCT interpretation aids in timely and appropriate management, improving patient outcomes and promoting #AntimicrobialStewardship. 💡 #Procalcitonin #InfectionControl #ClinicalMicrobiology #QualityCare #Healthcare