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Coagulase-negative staphylococci are an important cause of infections of intravascular and prosthetic devices and of wound infection following cardiothoracic surgery These organisms may infrequently cause infections such as osteomyelitis and endocarditis in the absence of a prosthesis Most human infections are caused by Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warnerii, Staphylococcus saprophyticus, Staphylococcus saccharolyticus, and Staphylococcus cohnii These common nosocomial pathogens are less virulent than S aureus, and infections caused by them tend to be more indolent Because coagulase-negative staphylococci are normal inhabitants of human skin, it is difficult to distinguish infection from contamination, the latter perhaps accounting for three-fourths of blood culture isolates Infection is more likely if the patient has a foreign body (eg, sternal wires, prosthetic joint, prosthetic cardiac valve, pacemaker, intracranial pressure monitor, cerebrospinal fluid shunt, peritoneal dialysis catheter) or an intravascular device in place Purulent or serosanguineous drainage, erythema, pain, or tenderness at the site of the foreign body or device suggests infection Instability and pain are signs of prosthetic joint infection Fever, a new murmur, instability of the prosthesis, or signs of systemic embolization are evidence of prosthetic valve endocarditis Immunosuppression and recent antimicrobial therapy are risk factors Infection is also more likely if the same strain is consistently isolated from two or more blood cultures (particularly if samples were obtained at different times) and from the foreign body site Contamination is more likely when a single blood culture is positive or if more than one strain is isolated from blood cultures The antimicrobial susceptibility pattern and speciation are used to determine whether one or more strains have been isolated More sophisticated typing methods, eg, pulse-field gel electrophoresis of restriction enzyme digested chromosomal DNA, may be required to identify distinct strains Whenever possible, the intravascular device or foreign body suspected of being infected by coagulase-negative staphylococci should be removed However, removal and replacement of some devices (eg, prosthetic joint, prosthetic valve, cerebrospinal fluid shunt) can be a difficult or risky procedure, and it may sometimes be preferable to treat with antibiotics alone with the understanding that the probability of cure is reduced and that surgical management may eventually be necessary Coagulase-negative staphylococci are commonly resistant to -lactams and multiple other antibiotics For patients with normal renal function, vancomycin, 1 g intravenously every 12 hours, is the treatment of choice for suspected or confirmed infection caused by these organisms until susceptibility to penicillinase-resistant penicillins or other agents has been confirmed Duration of therapy has not been established for relatively uncomplicated infections, such as those secondary to intravenous devices, which may be eliminated by simply removing the infected device Infection involving bone or a prosthetic valve should be treated for 6 weeks A combination.

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S aureus produces toxins that cause three important entities: scalded skin syndrome in children, toxic shock syndrome in adults, and enterotoxin food poisoning Toxic shock syndrome is characterized by abrupt onset of high fever, vomiting, and watery diarrhea Sore throat, myalgias, and headache are common Hypotension with renal and cardiac failure is associated with a poor outcome A diffuse macular erythematous rash and nonpurulent conjunctivitis are common, and desquamation, especially of palms and soles, is typical during recovery Fatality rates may be as high as 15% Although originally associated with tampon use, any focus (eg, nasopharynx, bone, vagina, rectum, abscess, or wound) harboring a toxin-producing S aureus strain can cause toxic shock syndrome and nonmenstrual cases of toxic shock syndrome are common Classically, blood cultures are negative because symptoms are due to the effects of the toxin and not systemic infection Important aspects of treatment include rapid rehydration, antistaphylococcal drugs, management of renal or cardiac failure, and addressing sources of toxin, eg, removal of tampon or drainage of abscess

using using using using System; System.Collections.Generic; System.Linq; System.Text;

regimen of vancomycin plus rifampin, 300 mg orally twice daily, and gentamicin, 1 mg/kg intravenously every 8 hours, is recommended for treatment of prosthetic valve endocarditis caused by methicillin-resistant strains

Safdar N et al Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients Chest 2005 Aug;128(2):489 95 [PMID: 16100130]

Other bacteria can produce gas in infected tissue, eg, enteric gram-negative organisms, or anaerobes

Visual Studio inserted these for you automatically. These using statements provide a shorthand way to access various parts of the .NET Framework that you might want to use in your program. In fact, you used only the first one this time around, but it doesn t hurt anything to have the others there. We ll discuss the System part in just a minute. The next line in the program defines a namespace:

Penicillin, 2 million units every 3 hours intravenously, is effective Other agents (eg, tetracycline, clindamycin, metronidazole, chloramphenicol, cefoxitin) are active against Clostridium species in vitro and probably in vivo as well Adequate surgical debridement and exposure of infected areas are essential, with radical surgical excision often necessary Hyperbaric oxygen therapy has been used empirically but must be used in conjunction with administration of an appropriate antibiotic and surgical debridement

CLOSTRIDIAL DISEASES 1 Clostridial Myonecrosis (Gas Gangrene)

Sudden onset of pain and edema in an area of wound contamination Prostration and systemic toxicity Brown to blood-tinged watery exudate, with skin discoloration of surrounding area Gas in the tissue by palpation or radiograph Gram-positive rods in culture or smear of exudate

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Sudden onset after medical abortion Abdominal pain Absence of fever Tachycardia, severe hypotension, capillary leak syndrome with edema Profound leukocytosis, hemoconcentration

Gas gangrene or clostridial myonecrosis is produced by any one of several clostridia (Clostridium perfringens, Clostridium ramosum, Clostridium bifermentans, Clostridium histolyticum, Clostridium novyi, etc) Trauma and injection drug use are common predisposing conditions Toxins produced in devitalized tissues under anaerobic conditions result in shock, hemolysis, and myonecrosis

(In the preceding example, type your password at the password prompt.) This method enables you to run a command as root for a defined interval (usually five minutes) without retyping your password. Second, to enable root access indefinitely, use sudo with the s option and enter your password at the password prompt:

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