First Described Case of Group B Streptococcus

Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities. Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcus was treated successfully with IR guided drainage and antibiotics. Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess

Outcome Measurements in Chronic Neuropathic Pain Patients Receiving Multiple Rounds of Ketamine Infusions.

Background: Chronic neuropathic pain is known to impact many aspects of quality of life (QOL). Ketamine, a phenycyclidine derivative with both anesthetic and analgesic properties, has been previously shown to provide relief in patients receiving outpatient infusions of the drug. Objective: To assess the effect of outpatient ketamine infusions on QOL outcome measurements in patients with chronic neuropathic pain who have received several rounds of ketamine infusions. Methods: Patients with chronic neuropathic pain were asked to complete the brief pain inventory (BPI) concerning the impact of their chronic pain on aspects of their QOL (overall daily pain score, general activity, walking, work, relationship with others, sleep, and enjoyment of life) before receiving ketamine infusion and two to four weeks after the ketamine infusions at the follow up clinic visit. The patients ranked the impact of pain on QOL, from a scale of zero (no impact) to ten (severely impacts). Overall change in QOL both prior to treatment with ketamine infusion and after administration were evaluated. Four predictors (age, sex, race, and BMI) were also used in order to evaluate any change on QOL due to demographics. Only patients who received more than one infusion were included in the study. Results: There were 34 patients in the sample, with mean age 43.0 (SD 12.8), mean BMI 26.0 (SD 8.2), 68% female, 74% white, 18% black, and 9% other or unknown race. 11 patients had 2 episodes of ketamine infusion, 6 had 3 episodes, and the remaining 17 patients had between 4 and 19 episodes (median number of episodes = 3.5). The model predicting mean BPI score pre-infusion (using each subject’s first episode of ketamine infusion only), was significant (p=.036), indicating a significant effect with moderate effect size. The only predictor with a significant independent association with mean BPI pre-infusion was pain (p=.0042). The model predicting post-infusion mean BPI score was not significant (p=.59). In the model predicting change from pre to post-infusion in mean BPI score at episode 1, the only significant predictor was BMI (p=.041). In the mixed model predicting pre-infusion mean BPI across repeated episodes of ketamine infusion, there was a significant episode effect (p=.029). After adjusting for covariates, the mean pre-infusion BPI scores at episodes 2 through 15 are not significantly different from episode 1, but starting with episode 16, all later episodes have significantly lower pre-infusion BPI scores than episode 1. In the model predicting the pattern of pre-infusion BPI scores across episodes, there was a significant interaction by age (p=.016), with older patients have reduced pre-infusion BPI scores at episodes 5 & 12, compared with younger patients. Conclusion: Expanding upon our previous study, we examined QOL outcomes for returning ketamine infusion patients with chronic neuropathic pain based on their BPI scores. Ketamine infusions were found to continuously improve patient’s pain scores over multiple rounds of infusion. Ketamine infusions were also found to have greater affect in older patients as well as patients with a greater BMI. However, other predictors or QOL were not found to be significantly different

First Described Case of Group B Streptococcus Pelvic Abscess in a Patient with No Medical Comorbidities

Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities. Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcus was treated successfully with IR guided drainage and antibiotics. Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess

First Described Case of Group B Streptococcus Pelvic Abscess in a Patient with No Medical Comorbidities

Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities. Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcuswas treated successfully with IR guided drainage and antibiotics. Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess

Outcome ketamine infusions: is there a difference between 1 and 3-day infusions?

Introduction: Chronic pain impacts many aspects of a patient’s quality of life (QOL). Ketamine is a NMDA receptor antagonist that has been used for neuropathic pain. This study aims to: (1) evaluate the impact of outpatient ketamine infusions on pain and QOL with a larger sample size than our previous study; (2) determine if there is a difference in results in patients receiving 1 or 3-day infusions; and, (3) examine whether repeated infusions have an influence on outcomes. Methods: With IRB approval, 118 patients completed the basic pain inventory (BPI) to rate, on a scale from 0 to 10, their pain and the degree pain interfered with QOL (general activity, walking, work, relationships, mood, sleep, and enjoyment of life). The BPI was completed prior to 1 or 3-day infusions and was repeated 2-4 weeks after infusions. Paired two tailed t-tests and random effect mixed models were used to compare post and pre-infusion scores. Results: There was statistically significant improvement (p\u3c0.05) in pain, enjoyment of life, general activity, mood, work, relationships, and sleep, but not walking (p= 0.2419). There was no significant difference in outcomes between 1 and 3-day infusions. However, this may be overstated, as there was a small sample of 1-day infusions. Repeaters had significant cumulative improvement in enjoyment of life (p= 0.0132) and relationships (p= 0.0092) with increased number of repeated infusions. Conclusion: 1 and 3-day outpatient ketamine infusions improve pain levels and QOL and may provide cumulative benefits with repeated infusions in patients with chronic neuropathic pain. References Collins, S., et al. NMDA receptor antagonists for the treatment of neuropathic pain. Pain Med, 2010. 11(11): p. 1726-42. Niesters, M., C. Martini, and A. Dahan. Ketamine for chronic pain: risks and benefits. Br J Clin Pharmacol, 2014. 77 (2): p. 357-67. Introduction: Chronic pain impacts many aspects of a patient’s quality of life (QOL). Ketamine is a NMDA receptor antagonist that has been used for neuropathic pain. This study aims to: (1) evaluate the impact of outpatient ketamine infusions on pain and QOL with a larger sample size than our previous study; (2) determine if there is a difference in results in patients receiving 1 or 3-day infusions; and, (3) examine whether repeated infusions have an influence on outcomes. Methods: With IRB approval, 118 patients completed the basic pain inventory (BPI) to rate, on a scale from 0 to 10, their pain and the degree pain interfered with QOL (general activity, walking, work, relationships, mood, sleep, and enjoyment of life). The BPI was completed prior to 1 or 3-day infusions and was repeated 2-4 weeks after infusions. Paired two tailed t-tests and random effect mixed models were used to compare post and pre-infusion scores. Results: There was statistically significant improvement (p\u3c0.05) in pain, enjoyment of life, general activity, mood, work, relationships, and sleep, but not walking (p= 0.2419). There was no significant difference in outcomes between 1 and 3-day infusions. However, this may be overstated, as there was a small sample of 1-day infusions. Repeaters had significant cumulative improvement in enjoyment of life (p= 0.0132) and relationships (p= 0.0092) with increased number of repeated infusions. Conclusion: 1 and 3-day outpatient ketamine infusions improve pain levels and QOL and may provide cumulative benefits with repeated infusions in patients with chronic neuropathic pain. References Collins, S., et al. NMDA receptor antagonists for the treatment of neuropathic pain. Pain Med, 2010. 11(11): p. 1726-42. Niesters, M., C. Martini, and A. Dahan. Ketamine for chronic pain: risks and benefits. Br J Clin Pharmacol, 2014. 77 (2): p. 357-67