Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases
Gram-positive organisms are known causative agents in toxic shock syndrome (TSS), an acute disease caused by bacterial exotoxins. During routine instrumentation removal for chronic osteomyelitis, intraoperative debridement, reaming, and irrigation can lead to cell lysis and subsequent dissemination...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Trauma Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235264402300136X |
| _version_ | 1827819134371495936 |
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| author | Michael Ulmer Christopher R. Rehak John C.P. Floyd Robert M. Harris |
| author_facet | Michael Ulmer Christopher R. Rehak John C.P. Floyd Robert M. Harris |
| author_sort | Michael Ulmer |
| collection | DOAJ |
| description | Gram-positive organisms are known causative agents in toxic shock syndrome (TSS), an acute disease caused by bacterial exotoxins. During routine instrumentation removal for chronic osteomyelitis, intraoperative debridement, reaming, and irrigation can lead to cell lysis and subsequent dissemination of the bacterium exotoxin, which can result in acute cardiovascular compromise. We present two cases of chronic osteomyelitis in healed long-bone fractures that were treated with deep instrumentation removal and surgical debridement using a reamer-irrigator-aspirator (RIA) system. Both patients had positive Streptococcus agalactiae wound cultures and both developed acute intraoperative hypotension during the reaming/irrigation portion of the procedure. Case 1 experienced cardiac arrest and was resuscitated for several days in the ICU. Case 2 underwent intra-operative hypotension and was resuscitated appropriately. The RIA or standard reaming systems must be used with caution during debridement of osteomyelitis in the presence of known toxin producing bacteria. The risk of iatrogenic spread of infection or extravasation of intramedullary contents is present; a high index of suspicion with any change in vital signs and prompt response can help mitigate the effect of adverse outcomes associated with acute and severe intraoperative hypotension. |
| first_indexed | 2024-03-12T01:10:45Z |
| format | Article |
| id | doaj.art-698922631e364abbba87d5bdb62190f1 |
| institution | Directory Open Access Journal |
| issn | 2352-6440 |
| language | English |
| last_indexed | 2024-03-12T01:10:45Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Trauma Case Reports |
| spelling | doaj.art-698922631e364abbba87d5bdb62190f12023-09-14T04:54:06ZengElsevierTrauma Case Reports2352-64402023-10-0147100888Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two casesMichael Ulmer0Christopher R. Rehak1John C.P. Floyd2Robert M. Harris3Jack Hughston Memorial Hospital Residency, 4401 Riverchase Drive, Phenix City, AL 36867, United States of America; Corresponding author at: Jack Hughston Memorial Hospital Residency, The Hughston Foundation, Inc., 4401 Riverchase Drive, Phenix City, AL 36867, United States of America.Mercer University School of Medicine, 1633 1st Avenue, Columbus, GA 31901, United States of AmericaHughston Foundation Inc., Hughston Clinic, 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31909-9517, United States of AmericaHughston Foundation Inc., Hughston Clinic, 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31909-9517, United States of AmericaGram-positive organisms are known causative agents in toxic shock syndrome (TSS), an acute disease caused by bacterial exotoxins. During routine instrumentation removal for chronic osteomyelitis, intraoperative debridement, reaming, and irrigation can lead to cell lysis and subsequent dissemination of the bacterium exotoxin, which can result in acute cardiovascular compromise. We present two cases of chronic osteomyelitis in healed long-bone fractures that were treated with deep instrumentation removal and surgical debridement using a reamer-irrigator-aspirator (RIA) system. Both patients had positive Streptococcus agalactiae wound cultures and both developed acute intraoperative hypotension during the reaming/irrigation portion of the procedure. Case 1 experienced cardiac arrest and was resuscitated for several days in the ICU. Case 2 underwent intra-operative hypotension and was resuscitated appropriately. The RIA or standard reaming systems must be used with caution during debridement of osteomyelitis in the presence of known toxin producing bacteria. The risk of iatrogenic spread of infection or extravasation of intramedullary contents is present; a high index of suspicion with any change in vital signs and prompt response can help mitigate the effect of adverse outcomes associated with acute and severe intraoperative hypotension.http://www.sciencedirect.com/science/article/pii/S235264402300136XGram-positive organismsReamer-irrigator-aspirator (RIA) systemStreptococcus agalactiaeHealed long-bone fractureInstrumentation removal |
| spellingShingle | Michael Ulmer Christopher R. Rehak John C.P. Floyd Robert M. Harris Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases Trauma Case Reports Gram-positive organisms Reamer-irrigator-aspirator (RIA) system Streptococcus agalactiae Healed long-bone fracture Instrumentation removal |
| title | Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases |
| title_full | Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases |
| title_fullStr | Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases |
| title_full_unstemmed | Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases |
| title_short | Acute toxic shock syndrome associated with intra-operative debridement and instrumentation removal for chronic osteomyelitis: A report of two cases |
| title_sort | acute toxic shock syndrome associated with intra operative debridement and instrumentation removal for chronic osteomyelitis a report of two cases |
| topic | Gram-positive organisms Reamer-irrigator-aspirator (RIA) system Streptococcus agalactiae Healed long-bone fracture Instrumentation removal |
| url | http://www.sciencedirect.com/science/article/pii/S235264402300136X |
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