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Objectives: To describe the outcome and risk factors for treatment failure of 76 Gram-negative bacilli (GNB) prosthetic joint infections (PJIs) managed with a curative intent according to a standardized protocol derived from published guidelines.Methods: We analysed data from all the cases of GNB-PJI treated surgically over an 8 year period. Treatment failure was defined as persistence or recurrence of PJI signs during follow-up, resulting in additional surgery and/or antibiotic administration or death.Results: Treatment failure within the follow-up period (median = 2.6 years) was observed in 16 of 76 (21.1%) patients. The failure rate was similar whether the patients were treated with fluoroquinolones in the whole cohort (22.4% versus 16.7%, P = 0.75) and after stratification according to the surgical procedure. The low failure rate observed in patients not receiving fluoroquinolones might be explained by the standardized attitude of maintaining intravenous β-lactams throughout treatment duration (median = 90 days). In multivariate analysis, C-reactive protein level ≥175 mg/L was significantly associated with treatment failure (adjusted HR = 7.75, 95% CI = 2.66-22.59, P < 0.0001).Conclusions: Management according to standardized procedures may improve the prognosis of GNB-PJI. Intravenous β-lactams, continued for 3 months, should be considered an effective alternative to fluoroquinolones. [ABSTRACT FROM AUTHOR]

The article presents two case studies one of a 48-year-old man and other of a 67-year-old man who were diagnosed with atypical Whipple's disease associated with cytoplasmic anti-neutrophil cytoplasmic antibodies (ANCA) of undefined specificity. It is reported that, cardiac ultrasonography was performed on the 48-year-old man which revealed the existance of left ventricular ejection fraction of 60%, without valvulopathy.

Reports four cases of immunoglobulin E-mediated adverse reactions to tetanus toxoid vaccine. Clinical significance of specific immunoglobulin E to tetanus toxoid; Description of aluminum-containing adjuvants; Reaction proneness to tetanus toxoid vaccine.