Search

Introduction: Cervical spondylodiscitis is usually caused by pyogenic infections, associated with retropharyngeal abscesses, or due to the swallowing of foreign bodies. No cases of cervical spondylodiscitis caused by a penetrating neck injury have been published in the literature. We describe a case of cervical spondylodiscitis after multiple knife stab wounds to the lateral soft tissue of the neck., Materials and Methods: Case report and review of the literature., Results: A 54-year-old patient was brought to our clinic with destructive spondylodiscitis C3/4 with paravertebral and epidural abscesses. He had been involved in a fight and had suffered multiple stab wounds to his neck with a knife 1 month prior. The initial CT scan had revealed one deeper wound canal behind the sternocleidomastoid muscle on the left side without any injury to the vessels. The wound was cleaned and an antibiotic therapy with cefuroxime was given for 1 week. After an uneventful and complete healing of the wound the patient developed severe neck pain. Inflammatory laboratory parameters were elevated, and a MRI of the neck revealed a distinct spondylodiscitis C3/4 with paravertebral and epidural abscess formations. Surgery was performed and included debridement, abscess drainage, decompression of the spinal canal, fusion of the C3/4 segment using an autologous iliac crest bone graft and a plate osteosynthesis. A course of calculated antibiotic therapy was administered for 8 weeks. Normal laboratory parameters and no radiological signs of an ongoing inflammatory process were observed during follow-up examinations. The C3/4 segment was consolidated., Conclusion: Stab wound injuries to the neck not only bear the risk of injuries to the nerves, vessels and organs of the neck but also increase the risk of developing secondary spondylodiscitis. Specifically, cervical spondylodiscitis can result in distinct neurological symptoms, and surgical intervention should be performed in a timely manner., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

From October 1993 till October 1994, 115 oxacillin resistant Staphylococus aureus strains were isolated in the laboratory of a teaching hospital. This was 2.4% of all of the Staphylococcus aureus strains. The bacteria were isolated from 30 patients, 7 medical personnel and in the environment of the infected patients. Most of the isolates were cultured from blood cultures, wound swabs and drains. If the referring hospitals has been informed about the MRSA status of the patients, several transmissions could have been prevented. In 10 infected patients, the MRSA strains were isolated from the nose, throat and hands. The isolates were also found on the hands of several personnel and in the patients environment, suggesting that the strains had been widely spread. The MRSA strains predominated in the medical and surgical intensive care units and in 2 general surgical wards. They were only found sporadically in other departments (Ophthalmology, Gynaecology, Paediatrics and Urology). MRSA-strains were more resistant to imipenem, ofloxacin, gentamicin, trimethoprim-sulfamethoxazole, tetracycline, erythromycin and clindamycin as oxacillin-sensitive Straphylococcus aureus strains. Genotyping (Restriction-Fragment-Length-Polymorphism) revealed six different strain patterns. The same RFLP types were mainly found on different wards. We conclude that various clones of MRSA may have emerged independently within one hospital and that their spread between wards was remarkably limited. Subsequent intensive hygiene measures have been successful in reducing the number of new isolates.

The bacteriological flora of the foot and shoe was studied concurrently in 200 volunteers without foot injuries, and 80 patients with puncture wounds of the foot. Seven of 28 child patients developed clinical infections, three with Pseudomonas aeruginosa. Eleven of 52 adult patients also developed infections. No patients developed infection if oral antibiotics were given within the first 24 h after injury (P < 0.05). Oral antibiotic prophylaxis is recommended for puncture wounds of the foot.