Bacterial Endocarditis Occurring After Open-Heart Surgery

A review was made of 520 patients who survived cardiopulmonary bypass for repair of congenital or acquired heart disease between 1956 and 1965. The incidence of early and late bacterial endocarditis was 2.7%, a figure which was higher than the reported incidence in the pre-bypass era but comparable to the experience reported by others. When those patients who had ball-valve prostheses inserted were considered separately, endocarditis was found to have occurred in 3.9%. The most common infecting organism was Staphylococcus albus (nine of 14 cases). Twelve of the 14 patients died, most often from complications of the infection, such as disruption of patches and prosthetic valves. The infections were difficult to control and in three patients recurred from one to three times. There was no apparent source of infection. Six patients developed infections six to 45 months after operation; the remaining eight had proved endocarditis within two months of operation. With one possible exception, treatment with antibiotics appeared to be ineffective in eradicating the infection unless foreign material was removed from the heart.     

Bacteremia caused by viridans streptococci in 71 children.

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient''s illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient''s illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient''s illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.     

The dental awareness of nursing home staff in Singapore - a pilot study

Objective: The aim of this pilot study was to assess the oral health knowledge among staff working in a local nursing home managed by a voluntary welfare organisation. Method: A self‐administered questionnaire was completed by 53 nursing staff working in a home with 270 residents. The questionnaire was structured to assess the staff's knowledge of dental caries, periodontal disease and the care and use of dentures. Results: 99.6% of the respondents felt that oral health care of the elderly was very important. However, only 45.3% of them attributed the cause of dental caries to the frequent intake of sugar. Bacteria in dental plaque was identified by 88.7% of them as the main cause of periodontal disease while 96.2% of them indicated that dentures should be cleaned at least once a day and rinsed after every meal. Conclusion: The staff of this nursing home demonstrated positive knowledge of periodontal disease and denture care. However, their knowledge of dental caries revealed substantial room for improvement. This could signal an area for future staff training and development. Such efforts would help establish a team of caregivers who can improve the oral health and quality of life for residents in the nursing home.     

Biofilms in device-related infections

The use of various medical devices including indwelling vascular catheters, cardiac pacemakers, prosthetic heart valves, chronic ambulatory peritoneal dialysis catheters and prosthetic joints has greatly facilitated the management of serious medical and surgical illness. However, the successful development of synthetic materials and introduction of these artificial devices into various body systems has been accompanied by the ability of microorganisms to adhere to these devices in the environment of biofilms that protect them from the activity of antimicrobial agents and from host defense mechanisms. A number of host, biomaterial and microbial factors are unique to the initiation, persistence and treatment failures of device-related infections. Intravascular catheters are the most common devices used in clinical practice and interactions associated with these devices are the leading cause of nosocomial bacteremias. The infections associated with these devices include insertion site infection, septic thrombophlebitis, septicemia, endocarditis and metastatic abscesses. Other important device-related infections include infections of vascular prostheses, intracardiac prostheses, total artificial hearts, indwelling urinary catheters, orthopedic prostheses, endotracheal tubes and extended wear lenses. The diagnosis and management of biofilm-associated infections remain difficult but critical issues. Appropriate antimicrobial therapy is often not effective in eradicating these infections and the removal of the device becomes necessary. Several improved diagnostic and therapeutic modalities have been reported in recent experimental studies. The clinical usefulness of these strategies remains to be determined.     

Biocultural implications of oral pathology in an ancient Central California population

Bioarchaeologists have long noted two unusual trends in the dentitions of prehistoric Native Californian populations: high rates of wear and low prevalence of caries. The Central California site of CA‐CCO‐548 offers a unique opportunity to examine the relationship between oral pathology and extreme dental wear in a large (n = 480), ancient (4,300–3,100 BP), and temporally well‐defined population sample. This study specifically examines three interrelated processes of the oral cavity in this population: dental wear, dental caries, and periodontal disease. The results show high levels of dental wear (average of 6.1, Smith system), low frequencies of carious lesions (2.5%), low frequencies of periodontal disease (17.8%), and high frequencies of periapical abscesses (10.7%). The pathological processes examined here have complicated multifactorial etiologies. However, they all share the common primary etiological agents of facultative pathogenic bacteria proliferation in the oral biofilm. Integration of the current etiological explanations for infections of the oral cavity, information from the ethnographic record pertaining to subsistence and activity patterns in Native Californian populations, and statistical analysis of specific disease and wear patterns leads to a novel explanation for the observed pattern of oral pathology in this population sample. Specifically, the introduction of antibacterial compounds through dietary items and non‐alimentary tooth use is suggested as the most likely explanation for the unusually low prevalence of dental caries and periodontal disease. Am J Phys Anthropol 154:171–188, 2014. © 2014 Wiley Periodicals, Inc.     

Cloxacillin and Sodium Fusidate in Management of Shunt Infections

The effectiveness of two oral antibiotics, cloxacillin and sodium fusidate, has been evaluated in the treatment of shunt infections among 37 patients allocated at random to two treatment groups. Both proved to be safe bactericidal agents giving adequate serum M.I.C. when taken by mouth. Treatment should always be started on the basis of the clinical presentation without waiting for the bacteriologist''s report. The commonest infecting organism is Staphylococcus aureus. Nine shunts were lost in this study, eight through Staphylococcus aureus infection. The nasal carrier state is of considerable importance in perpetuating these shunt infections.     

The implication of probiotics in the prevention of dental caries

The current oral health crisis, whose causes are varied and complex, necessitates timely oral evaluation and early detection and treatment of oral health problems. Dramatic changes in eating habits and lifestyles are associated with the recent decline in oral health. Probiotics are “good” bacteria that support digestion and a healthy immune system and offer various health benefits to the host. Traditionally, probiotics have been used to improve gut health; the most common uses have historically been as a treatment or prevention of gastrointestinal infections and disease. During the last decade, studies have additionally suggested the intake of probiotics for oral health purposes. Probiotic use provides an effective strategy to combat oral disease, including the development of dental caries and periodontal infection. The aim of this review is to describe the beneficial roles of probiotic bacteria in the oral cavity and the potential mechanisms by which these bacteria exert their effects on oral health.

     

Muscle-flap coverage of exposed endoprostheses

A well-entrenched tenet in the orthopedic community is that dehiscent wounds overlying exposed endoprostheses should be treated by implant removal and delayed reconstruction. A new management protocol utilizing thorough soft-tissue debridement and myocutaneous or muscle-flap coverage was evaluated in four patients at the UCLA Medical Center who presented with exposed endoprostheses. These prostheses were placed for total-joint replacement or limb salvage surgery. All four prostheses and extremities were salvaged without the need for endoprosthesis removal or exchange, and no infections developed. The results suggest that late aseptic wound dehiscence with an exposed endoprosthesis need not be managed with prosthetic removal, arthrodesis, or amputation. This one-stage procedure avoided infection, allowed early mobilization, and shortened hospitalization.     

Oral health and frailty in the medieval English cemetery of St Mary Graces

The analysis of oral pathologies is routinely a part of bioarcheological and paleopathological investigations. Oral health, while certainly interesting by itself, is also potentially informative about general or systemic health. Numerous studies within modern populations have shown associations between oral pathologies and other diseases, such as cardiovascular disease, certain types of cancer, and pulmonary infections. This article addresses the question of how oral health was associated with general health in past populations by examining the relationship between two oral pathologies (periodontal disease and dental caries) and the risk of mortality in a cemetery sample from medieval England. The effects of periodontitis and dental caries on risk of death were assessed using a sample of 190 individuals from the St Mary Graces cemetery, London, dating to ～AD 1350–1538. The results suggest that the oral pathologies are associated with elevated risks of mortality in the St Mary Graces cemetery such that individuals with periodontitis and dental caries were more likely to die than their peers without such pathologies. The results shown here suggest that these oral pathologies can be used as informative indicators of general health in past populations. Am J Phys Anthropol, 2010. © 2009 Wiley‐Liss, Inc.     

Usefulness of new wetness tester for diagnosis of dry mouth in disabled patients

Objectives: The condition of dry mouth is an influential factor in the incidence of caries, periodontal disease, fungal infections, masticatory dysfunctions and denture function. Bedridden elderly and disabled persons often suffer from oral dryness and the aim of this study was to evaluate the usefulness of measuring the amount of moisture in the oral mucosa for clinical diagnosis of dry mouth in this group. Subjects and methods: The subjects were 20 elderly bedridden individuals, age range 65–89 years old, living in a nursing home and six healthy laboratory researchers, aged 20–46 years old, used as controls. Tongue dorsum moisture measurements were performed using a newly developed wetness tester (L‐SALIVO^®), in which the wet portion was measured after 10 s. Further, clinical diagnosis of dry mouth was carried out using a clinical classification scale of the tongue mucosa (grade range, 0–3). Results: It was possible to measure tongue dorsum moisture in all subjects with the wetness tester. The average moisture value was 0.1 ± 0.2 mm in elderly subjects with a dry mouth grade of 2 (n = 8) or 3 (n = 12), while the average moisture value in the control subjects was 3.67 ± 1.75 mm with a dry mouth grade of 0 (n = 4) or 1 (n = 2). Tester values and clinical classification showed a positive co‐relationship (r = 0.31, p < 0.05). Conclusions: Our results show that this new tester could be useful for evaluating oral dryness and diagnosing dry mouth.     

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly

doi: 10.1111/j.1741‐2358.2010.00446.x
Analysis of socio‐demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly Objective: To investigate the association of socio‐demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals. Material and methods: A cross‐sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi‐square test and Fisher’s exact test. An estimation of prevalence for the covariates was performed using Poisson’s regression models. Results: The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower‐income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60–64 years old and those who are employed had a significant association with periodontal disease. Conclusion: Socio‐demographic factors were associated with some notable oral diseases in the elderly.     

Pathogenic synergy: mixed infections in the oral cavity

In almost all infections in the oral cavity, mixed populations of bacteria are present. However, recent evidence points to a certain specificity in these infections:Streptococcus mutans is related to caries and black-pigmentedBacteroides species are suspected pathogens in periodontal disease. Periodontal diseases, endodontic infections and submucous abscesses in the oral cavity are probably mixed infections in which anaerobic bacteria together with facultatives or other anaerobes are present. In experimental mixed anaerobic infections black-pigmentedBacteroides strains have been shown to play a key role. Little is known about the pathogenic synergy between the bacteria involved in mixed infections. Important mechanisms could be nutritional interrelationships and interactions with the host defense. Within the group of black-pigmentedBacteroides B. gingivalis seems to be the most virulent species. These bacteria possess a great number of virulence factors, which might be important in the pathogenesis of oral infections.     

Effects of antimicrobial peptide L-K6, a temporin-1CEb analog on oral pathogen growth,Streptococcus mutans biofilm formation,and anti-inflammatory activity

Dental caries and periodontitis are common bacterial mouth infections. As a potentially attractive substitute for conventional antibiotics, antimicrobial peptides have been widely tested and used for controlling bacterial infections. In this study, we tested the efficacy of the peptides from the skin secretions of Rana chensinensis for killing several major cariogenic and periodontic pathogens as well as Candida albicans. L-K6, a temporin-1CEb analog, exhibited high antimicrobial activity against the tested oral pathogens and was able to inhibit Streptococcus mutans biofilm formation and reduce 1-day-old S. mutans biofilms with a minimum biofilm inhibitory concentration and reducing concentration of 3.13 and 6.25 μM, respectively. The results of confocal laser scanning microscopy demonstrated that the peptide significantly reduced cell viability within oral biofilms. Furthermore, as little as 5 μM L-K6 significantly inhibited lipopolysaccharide (LPS)- and interleukin-1β-induced productions of interleukin-8 and tumor necrosis factor-α from THP-1 monocytic cells. This anti-inflammatory activity is associated with the binding of L-K6 to LPS and neutralizing LPS-induced proinflammatory responses in THP-1 cells, as well as dissociating LPS aggregates. Our results suggest that L-K6 may have potential clinical applications in treating dental caries by killing S. mutans within dental plaque and acting as anti-inflammatory agents in infected tissues.     

Oral health and reduction in respiratory capacity in a cohort of community-dwelling elderly people: a population-based 5-year follow-up study

Objectives: Several anaerobic bacteria originating in periodontal pockets have been isolated from infected lungs and pharyngeal microflora. Increased bacterial load in lungs is known to be a risk factor for decline in forced expiratory volume during the first second. The aim was to evaluate both cross‐sectionally and longitudinally the association between oral health status and forced expiratory volume during the first second (FEV₁) in older residents of the city of Jyväskylä, Finland. Design: Cross‐sectional and prospective cohort study over a 5‐year follow‐up. Setting: Research laboratory of the University of Jyväskylä. Participants: In 1990 dental status and FEV₁ were examined in 203 80‐year‐old people, of whom 88 survivors were retested 5 years later. Main outcome measures: Primary: dental status and FEV₁. Secondary: existence of pulmonary diseases, height, handgrip strength, smoking, and length of education. Results: Participants were regrouped into three categories according to their baseline oral health status. At baseline, men with complete prostheses had the lowest FEV₁. Five years later the greatest reduction in FEV₁ was seen in subjects with poor periodontal status or complete prostheses (?9.4%) while those with healthy periodontal status showed no reduction in FEV₁ values (+1.0%, p = 0.006). Conclusions: Periodontal infections and complete prostheses may be reservoirs for pathogens which may be harmful and partly explain the observed reduction in FEV₁ during ageing.     

Diabetes enhances dental caries and apical periodontitis in caries-susceptible WBN/KobSlc rats

Many epidemiologic studies have suggested that diabetes may be an important risk factor for periodontal disease. To determine whether diabetes induces or enhances periodontal disease or dental caries, dental tissue from diabetic male and nondiabetic female WBN/KobSlc rats and male and female age-matched nondiabetic F344 rats was analyzed morphologically and morphometrically for these 2 types of lesions. Soft X-ray examination revealed that the incidence and severity of both molar caries and alveolar bone resorption were much higher in male WBN/KobSlc rats with chronic diabetes than in nondiabetic female rats of the same strain. Histopathologic examination showed that dental caries progressed from acute to subacute inflammation due to bacterial infections and necrosis in the pulp when the caries penetrated the dentin. In the most advanced stage of dental caries, inflammatory changes caused root abscess and subsequent apical periodontitis, with the formation of granulation tissue around the dental root. Inflammatory changes resulted in resorption of alveolar bone and correlated well with the severity of molar caries. Our results suggest that diabetic conditions enhance dental caries in WBN/KobSlc rats and that periodontal lesions may result from the apical periodontitis that is secondary to dental caries.     

Oral health and history of respiratory tract infection in frail institutionalised elders

Objectives: The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects. Setting and Subjects: 302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist. Outcome Measures: The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders. Results: One third (33%) of the subjects had experienced at least one episode of RTI and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P=0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1–3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5–6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated. Conclusions: The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.     

The antimicrobial activity of compounds from the leaf and stem of Vitis amurensis against two oral pathogens

Nine compounds isolated from the leaf and stem of Vitis amurensis Rupr. (Vitaceae) were evaluated for their antimicrobial activity against two oral pathogens, Streptococcus mutans and Streptococcus sanguis, which are associated with caries and periodontal disease, respectively. The results of several antimicrobial tests, including MIC, MBC, and TBAI, showed that three compounds inhibited the growth of the test bacteria at concentrations ranging from 12.5 to 50 μg/mL. Among these compounds, compound 5, trans-ε-viniferin, displayed the strongest activity against S. mutans and S. sanguis with MIC values of 25 and 12.5 μg/mL, respectively. This is the first report on the antimicrobial activity of stilbenes and oligostilbenes isolated from the leaf and stem of V. amurensis. Thus, this result suggests that natural antimicrobial compounds derived from V. amurensis may benefit oral health as plaque-control agents for the prevention of dental caries and periodontal disease.     

Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

Objective

Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.

Methods

This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital''s infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection.

Results

Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.

Conclusions

We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.