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Escherichia coli, a growing health concern, produces extended spectrum β-lactamases (ESBL), which are causing public health onset infections in multiple countries. Geographical variations in the distribution and prevalence of ESBL-synthesizing E. coli have been observed, with India reporting the largest proportion (61%). The worldwide dissemination of ESBL-producing bacteria, along with the restricted availability of effective treatments, could exacerbate antibiotic resistance. The identification of ESBL synthesizing E. coli is crucial for its characterisation and epidemiology in specific geographical regions. In Nepal, a developing nation, research shows a high prevalence of antibiotic-resistant bacteria, particularly the ESBL strain. Our study aimed to identify ESBL-producing E. coli from patients with urinary tract complications from a tertiary hospital in Nepal. Out of 125 E. coli isolates, 15.6% were female and 1.2% male. The highest resistance was detected for ampicillin, cefazolin, cefotaxime, and ceftazidime, while less resistance was observed against nitrofurantoin, gentamicin, and imipenem. The study found that 51 (40.8%) E. coli isolates produced ESBLs, indicating a higher level of ESBL production among urinary tract infection patients.

Implant-related hypersensitivity is a well-established cause of failure after total hip arthroplasty but is a rare complication after total knee arthroplasty (TKA). It remains a relatively unpredictable and poorly understood cause of implant-related failure. This article describes 5 patients (6 knees) who presented with persistent pain and hypertrophic synovitis after TKA using a cobalt-chromium component. Extensive perioperative workup, including white blood cell count, erythrocyte sedimentation rate, C-reactive protein, joint aspiration, and intraoperative cultures, ruled out infection as a cause of the symptoms. All knees demonstrated appropriate ligamentous balance and were well aligned, with all components noted to be well fixed at revision. In all patients, the clinical condition improved dramatically after revision to zirconium femoral and titanium metal-backed tibial components. Pain and functional outcome scores improved in all patients. Intraoperative histopathology revealed a thickened synovium with either a predominantly lymphocytic or histiocytic monocellular response. Final pathology confirmed that no infection was present in any patient. The goal of TKA is to produce a well-performing, pain-free joint. When patients present with recurrent pain and synovitis after TKA, infection must be excluded. When infection and instability have been excluded, metal hypersensitivity should be considered as a cause of primary TKA failure. In these patients, revision to a zirconium femoral component can provide predictable and effective clinical improvement. [ABSTRACT FROM AUTHOR]