Life after colectomy for fulminant Clostridium difficile colitis: a 7-year follow up study

Background

The long-term prognosis of patients undergoing colectomy for fulminant Clostridium difficile colitis has not been well studied. The authors present 7-year survival trends in such patients.

Methods

Patients were identified through a pathologic database. Medical records were reviewed and follow-up phone calls made to determine relevant patient history, longevity, and quality of life.

Results

The 61 patients identified had mean and median survival of 18.1 and 3.2 months, respectively, and 1-year, 2-year, 5-year, and 7-year mortality of 68.5%, 79.6%, 88.9%, and 90.7%, respectively. Previous C difficile infection, hypotension, requirement of vasopressors, mental status changes, elevated arterial lactate, decreased platelet counts, intubation, and longer duration on nonoperative therapy were associated with in-hospital mortality. There were no factors correlated with long-term survival.

Conclusions

Patients who require colectomy for fulminant C difficile colitis have a poor prognosis with poor long-term survival and significant morbidity. Although there are several factors associated with in-hospital mortality, there were no factors correlated with long-term survival.     

Intubation difficile : il faut suivre les recommandations

Intubation and ventilation impossible mask is a dramatic situation with potentially serious consequences. We report the case of a patient of 43 years, followed for a goiter, which was scheduled for a total thyroidectomy under general anesthesia. Preoperative evaluation is not noted signs of compression or tracheal deviation, and there were no criteria predictive of intubation or difficult mask ventilation. The induction of anesthesia was standard. Mask ventilation was effective allowing paralysis. The standard laryngoscopy showed a score of Cormack and Lehane grade IV. Several attempts at intubation were made leading to a situation of intubation and ventilation impossible mask with deep desaturation. A tracheostomy was done urgently. The patient was operated on, six months later, with a fiber optic intubation. Through this case, the authors draw attention to the difficulty of achieving an emergency tracheotomy in the presence of goiter and emphasize the need for integration of different modes of learning and retention of management skills of the upper airway.     

Spontaneous clostridial myonecrosis after pregnancy – emergency treatment to the limb salvage and functional recovery: a case report

Clostridial myonecrosis (CM) is a rare, life threatening necrotizing infection of a skeletal muscle caused by Clostridium perfringens in the majority of cases. The diagnosis may be difficult because of few diagnostic and cutaneous signs early in its course. Standard therapy involves surgical debridements of a devitalized tissue and high‐dose organism‐specific antibiotic therapy. The hyperbaric oxygen has also showed its usefulness in the treatment of these infections. Autograft systems as tissue replacement, based on bioengineered materials, have been demonstrated to be safe and effective treatments for chronic wounds and a suitable physiotherapy is recommended for the recovery of functional impairments of upper extremities. We present a rare case of CM of right upper limb treated with a combination of standard treatments and new techniques.     

二氧化氯颗粒制剂对食源性致病菌的杀菌效果

目的了解二氧化氯颗粒制剂对食源性致病菌的杀灭效果及影响因素,为其在食品加工领域应用提供依据。方法采用悬液定量杀菌试验方法,对二氧化氯杀灭蜡样杆菌等几种食源性致病菌的效果进行了观察。结果用100 mg/L二氧化氯消毒液作用20 min,对金黄色葡萄球菌平均杀灭对数值可达到6.66。150 mg/L二氧化氯消毒液对蜡样杆菌芽孢作用20 min,平均杀灭对数值达到4.0以上;200 mg/L二氧化氯消毒液作用20 min,可达到完全杀灭。含300 mg/L二氧化氯消毒液对产气荚膜梭菌芽孢作用20 min,杀灭对数值可达到4.0以上;二氧化氯含量增加到350 mg/L作用20 min,可达到完全杀灭。在蜡样杆菌芽孢悬液内加入体积分数10%小牛血清,即可明显降低二氧化氯杀菌效果。二氧化氯对产气荚膜梭菌芽孢杀灭效果浓度效应比较明显,而时间效应只体现在10 min之内。结论二氧化氯对几种食源性致病菌杀灭效果较好,有机物对二氧化氯杀灭细菌芽孢效果影响明显。     

Adaptive immune response to Clostridium difficile infection: A perspective for prevention and therapy

Clostridium difficile infection (CDI) is one of the most important nosocomial illnesses and a major cause of morbidity and mortality. While initial treatment of CDI is usually successful, unprovoked relapses remain an important and frustrating problem. This review examines the literature describing the natural immune response to CDI, and to what extent it can explain the propensity for relapses. In particular, we discuss studies on antibody and, to a lesser extent, B cell and T cell responses in CDI. Despite years of study, there remains incomplete understanding of the natural antibody response to the major pathogenic toxins, TcdA and TcdB, and other bacterial antigens, in CDI. Recent literature suggests that a specific subset of neutralizing antibodies that target the putative carbohydrate‐binding domains of TcdB and possibly TcdA have the greatest protective ability. This is further supported by recent successful clinical trials of a humanized monoclonal antibody to the major toxin TcdB. A better understanding of how and why the most protective adaptive immune response develops may lead to improved vaccine and therapeutic targets for recurrent CDI.     

Second cycle of intralesional Collagenase Clostridium histolyticum for Peyronie's disease using the modified shortened protocol: Results from a retrospective analysis

The purpose of this study was to evaluate the effectiveness and safety of the second cycle of Collagenase Clostridium histolyticum injections using the modified shortened protocol. We performed a retrospective analysis on patients who had already undergone the first cycle of injections using the modified shortened protocol and requested more injections to improve the remaining curvature. The International Index of Erectile Function, the Peyronie's Disease Questionnaire and the Global Assessment of Peyronie's Disease questionnaire were self-administered to all patients. All the parameters were recorded at baseline, after the first cycle and after the second cycle of injections. All adverse events were recorded. Seventeen patients completed two cycles of injections. All patients had a reduction of the initial curvature after the first cycle, with a mean improvement of 17.4° (27.4%). After the second cycle, the reduction of the curvature was 7.9° (17.1%), and 29.4% of patients had no further improvement. No severe side effect was recorded. The results of the present study confirm the effectiveness and safety of the modified shortened protocol of Collagenase C. histolyticum injections for Peyronie's disease. However, the second cycle of three injections may be less effective, and patients may not be completely satisfied.     

Antimicrobial stewardship in daily practice: Managing an important resource

Antimicrobial stewardship is a recent concept that embodies the practical, judicious use of antimicrobials to decrease adverse outcomes from antimicrobials while optimizing the treatment of bacterial infections to reduce the emergence of resistant pathogens. The objectives of the present statement are to illustrate the principles of antimicrobial stewardship and to offer practical examples of how to make antimicrobial stewardship part of everyday hospital and outpatient practice. Vital components of antimicrobial stewardship include appropriate testing to diagnose whether infections are viral or bacterial, and using clinical follow-up rather than antibiotics in cases in which the child is not very ill and uncertainty exists. Other specific, important actions include questioning whether positive urine cultures are contaminated when there is no evidence of pyuria or inflammatory changes, and obtaining a chest radiograph to support a diagnosis of bacterial pneumonia. Optimizing the choice and dosage of antimicrobials also reduces the probability of clinical failures and subsequent courses of antimicrobials. A list of common clinical scenarios to promote stew-ardship is included.     

利用groupⅡ intron构建产气荚膜梭菌突变体

目的通过插入失活α毒素基因获得产气荚膜梭菌(Clostridium perfringens)突变体。方法利用MobilegroupⅡintron的自我剪切作用,对本室保藏的1株野生型C.perfringens的α基因plc插入失活。通过菌落PCR检测,以及观察突变株在哥伦比亚血琼脂培养基和脑心浸液培养基(4%卵黄)平板上的形态变化,进行阳性筛选。蛋白质免疫印迹分析α毒素蛋白活性。结果 PCR检测到α毒素突变体的plc基因中,存在Mobile groupⅡintron片段,并且观察到该菌在哥伦比亚鲜血琼脂平板培养基上的α毒素溶血环消失,在脑心浸液培养基(4%卵黄)平板上无白晕。蛋白质免疫印迹分析表明,plc突变体不表达α毒素蛋白。结论成功构建C.perfringensα毒素突变体,为后期探索C.perfringens口服疫苗打下了重要基础。