Infection control consequences – early Staphylococcal Scalded Skin Syndrome or Kawasaki Syndrome?

Childhood exanthemata are caused by a broad spectrum of common pathogens. Many exanthemata initially present very similarly, even though caused by different organisms, ranging from virus to bacteria and their respective toxins. In the majority of cases the diagnosis is only of academic value, since therapy does hardly differ. However, in some cases accurate and prompt diagnosis is paramount, since therapy and appropriate hygiene measures prevent morbidity and mortality. We present a case with two differential diagnoses, Staphylococcal Scalded Skin Syndrome and Kawasaki Syndrome, which demonstrates the importance of considering relatively rare conditions as the cause of a childhood exanthema and discuss differences in therapeutic and infection control management. From an infection control point of view, Staphylococcal Scalded Skin Syndrome is, in contrast to Kawasaki Syndrome, highly transmittable to other paediatric patients via the hands of the staff. Therefore maintaining correct hand hygiene as well as other infection control measures are of importance until the final diagnosis is established

Persistently elevated IgA antibodies to Mycoplasma pneumoniae in patients with internal carotid artery stenosis

Background: It has been suggested that Mycoplasma pneumoniae may play a role in the development of atherosclerosis, but to date this association is still a matter of debate due to conflicting findings

Outcome of the FUSION vascular graft for above-knee femoropopliteal bypass.

Although endovascular procedures have become popular for the treatment of patients with femoropopliteal occlusive disease, open surgical bypass is still required in a significant proportion of patients. Saphenous vein is the conduit of choice, but prosthetic bypass grafts are often necessary. The Peripheral Bypass Grafting: Prospective Evaluation of FUSION Vascular Graft for Above Knee Targets (PERFECTION) trial was performed to assess the clinical outcome of the FUSION vascular graft (Maquet Cardiovascular, Wayne, NJ), a novel bilayer prosthetic graft with an external expanded polytetrafluoroethylene inner layer and an outer knit polyester layer.Eligible study patients included those requiring prosthetic femoral-to-above-knee popliteal bypass for claudication, rest pain, or localized tissue loss without wet gangrene. During a 30-month period ending in March 2012, 117 patients were enrolled in the PERFECTION trial and underwent bypass with FUSION vascular grafts at 10 European investigational sites. Patients were followed up with duplex ultrasound imaging and ankle-brachial indices performed at 30 days, 6 months, and 12 months. The primary efficacy end point was 12-month primary patency of the study graft, assessable in 102 patients. Safety end points included all-cause mortality, major adverse events, amputation, and graft reinterventions.The 67 male (57.3%) and 50 female (42.7%) patients averaged 67.8 ± 8.9 years in age and were implanted with 6-mm (25 [21.4%]), 7-mm (26 [22.2%]), or 8-mm (66 [56.4%]) FUSION grafts. The 30-day primary graft patency was 95.3%, with five graft occlusions in the perioperative period. The 12-month primary rate was 85.6%, and the secondary patency rate was 93.2%. Ankle-brachial indices increased from a mean of 0.53 ± 0.20 preoperatively to 0.97 ± 0.16 at 30 days and 0.91 ± 0.22 at 12 months. There were no major amputations through 12 months of follow-up, 15 patients (12.8%) had graft reinterventions, one patient (0.9%) developed a graft infection, and five patients (4.3%) died of unrelated causes.The findings of the prospective, multicenter PERFECTION study confirm clinical utility of the FUSION vascular graft through 12 months of follow-up. Patency rates equal or exceed those reported with other nonbioactive vascular grafts. These observations suggest that the FUSION graft is a useful alterative to standard expanded polytetrafluoroethylene grafts and should be considered as an option in patients requiring prosthetic femoral-to-above-knee popliteal arterial reconstruction

In vitro evaluation of the antimicrobial efficacy of a new silver-triclosan vs a silver collagen-coated polyester vascular graft against methicillin-resistant Staphylococcus aureus

ObjectivesVascular graft infection is a rare but serious complication of vascular reconstructive surgery. This in vitro study investigated the antimicrobial efficacy of a new, silver-triclosan collagen-coated polyester vascular graft compared with a silver collagen-coated polyester vascular graft alone during the first 24 hours.MethodsThe antimicrobial efficacy of the investigated vascular grafts was assessed by performing a time-kill kinetic assay following Clinical and Laboratory Institute Standards-approved guidelines M26-A. For the purpose of the experimental study, the ATCC 33591 strain of methicillin-resistant Staphylococcus aureus (American Type Culture Collection, Manassas, Va) was used. All assays were repeated sixfold. Bacterial survival numbers were obtained at 1, 4, 8, 12, and 24 hours using a standard plate count procedure. Bactericidal activity was defined as a 3 log10 reduction factor (logRF), according to the approved guideline M26-A.ResultsBoth antimicrobial vascular grafts achieved >3 logRF and fulfilled the efficacy criterion for bactericidal activity but performed differently in their speed of antimicrobial action. The silver-triclosan vascular graft achieved 3.37 logRF after 8 hours, and the silver vascular graft showed a 4.19 logRF after 24 hours. The silver-triclosan graft yielded significantly lower colony-forming units/mL counts after 4 hours compared with the silver graft (4.29 × 104 vs 1.03 × 106; P = .031).ConclusionsBoth antimicrobial collagen-coated polymer vascular grafts showed bactericidal activity against methicillin-resistant Staphylococcus aureus in vitro. Although the silver-triclosan vascular graft showed a faster antimicrobial efficacy, the silver graft exhibited its antimicrobial properties after 24 hours. Which concept will protect an implanted vascular prosthetic graft better from bacterial contamination and subsequent infection needs to be investigated further in in vivo animal and clinical studies.Clinical RelevanceVascular graft infection is a rare but one of the most serious complications of vascular reconstructive surgery. Conservative treatment of prosthetic graft infections is rarely successful and is used only in patients with a high operative risk or apparently limited infection. The most pre-eminent strategy against this severe complication therefore is primary prevention of vascular graft infection. The use of antimicrobial vascular grafts might support prevention of vascular graft infection. Results of a standardized experimental study on the antimicrobial efficacy of the silver-triclosan collagen polyester vascular graft with an identical collagen polyester vascular graft containing silver alone are presented

Precision Medicine in Vascular and Endovascular Surgery

Personalized medicine and precision medicine are terms often used to refer to treatment strategies tailored specifically to individual characteristics of patients, as opposed to a one-size fits all approach [...